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Health Insurance Florida 2-40 Practice
Exam Questions #2 and answers
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care - answer Business overhead expense (Explanation:Business Overhead Expense
insurance is designed to reimburse a business for overhead expenses in the event a business
owner becomes disabled. Expenses such as rent, utilities, telephone, equipment, employees'
salaries, etc.)
All of the following are state or federal government programs that provide health insurance,
EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap - answer Medigap (Explanation:A Medigap policy is a Medicare supplement insurance
policy sold by private insurance companies to fill "gaps" in Medicare Parts A and B.)
What type of health insurance is available to assist low-income individuals? - answer Medicaid
What types of reserves are set aside and held by health insurance companies? - answer
Premium and Claims reserves (Explanation:Reserves are set aside for the payment of future
claims.)
Group health insurance is generally written on a basis that provides for dividends or experience
rating. What is the basis called? - answer Participating (Explanation:Group plans written by
mutual companies provide for dividends while stock companies frequently issue experience-
rated plans.)
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Which of the following is NOT TRUE regarding eligibility for subsidies for families under the new
health care act?
-For those who make between 100-400% of the Federal Poverty -Level
-Cannot be covered by an employer
-Cannot be eligible for Medicare
-Can be eligible for Medicaid - answer Can be eligible for Medicaid
Which of the following operates as a corporation, society, or association to provide life
insurance primarily for the mutual benefit of its members, has a lodge or social system with
rituals and representative form of government?
A) Mutual companies
B) Fraternal associations
C) Stock companies
-Fraternal benefit society - answer B) Fraternal associations
What does each member pay in a typical HMO plan?
-Fixed premium based on a deductible and copay
-Fixed premium whether or not plan is used
-Premium based on how often plan is used - answer Fixed premium whether or not plan is used
Which of the following is correct about those who are eligible for Medicare and wish to join an
HMO?
-They must have a current Medicare supplement policy
-They must be told that'll be getting all the benefits from the Medicare Advantage plan
-They must be age 70 and above
-They must have been enrolled previously in an HMO - answer They must be told that'll be
getting all the benefits from the Medicare Advantage plan
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Joyce is totally disabled. Her HMO policy just terminated. All of the following are correct
regarding "extension of benefits" for Joyce, EXCEPT?
-Coverage ends once maximum benefits have been exhausted
-Coverage ends once another carrier assumes coverage
-Coverage ends if no longer totally disabled
-Coverage ends after 18 months - answer Coverage ends after 18 months
All of the following are correct regarding Florida regulation of HMOs, EXCEPT?
-Must obtain a Certificate of Authority
-Must file a report of its activities within 3 months of the end of each fiscal year
-Must deposit $100,000 with the Rehabilitation Administration Expense Fund
-Must be sold by agents licensed and appointed as health insurance agents - answer Must
deposit $100,000 with the Rehabilitation Administration Expense Fund (Explanation:
They must deposit $10,000 with the Rehabilitation Administration Expense Fund.)
What is "capitation" as it relates to an HMO?
-Amount to be collected by the HMO from participating health care providers
-Fixed amount paid by an HMO during a policy period
-Fixed amount paid by an HMO to a physician for medical services
-Amount required to be deposited with the State of Florida - answer Fixed amount paid by an
HMO to a physician for medical services
When a person is covered by an HMO, the contract certificate or member's handbook must be
delivered within how many days after approval of the enrollment by the HMO?
-20 days
-10 days
-5 days
-14 days - answer 10 days
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Which of the following statements about health service organizations is true?
-They reimburse Policyowners directly for physicians' fees
-They provide loss of income benefits to Policyowners
-They reimburse Policyowners directly for all medical expenses
-They provide benefit payments directly to the hospitals and physicians providing services -
answer They provide benefit payments directly to the hospitals and physicians providing
services
What is the period of time for an HMO "open enrollment"?
-45 days during every 18-month period
-30 days during every 12-month period
-30 days during every 18-month period
-45 days during every 12-month period - answer 30 days during every 18-month period
If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can be
charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000 - answer Up to $200,00
Which of the following statements about Worker's Compensation laws is INCORRECT?
-Employers can purchase coverage through the state program, private insurers or can self-insure
-Worker's compensation provides benefits for work-related injuries, illness or death
-Not all states have a workers compensation law
-Basic principle is that work-related injuries are compensable by the employer without regard to
fault - answer Not all states have a workers compensation law
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Health Insurance Florida 2-40 Practice
Exam Questions #2 and answers
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care - answer Business overhead expense (Explanation:Business Overhead Expense
insurance is designed to reimburse a business for overhead expenses in the event a business
owner becomes disabled. Expenses such as rent, utilities, telephone, equipment, employees'
salaries, etc.)
All of the following are state or federal government programs that provide health insurance,
EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap - answer Medigap (Explanation:A Medigap policy is a Medicare supplement insurance
policy sold by private insurance companies to fill "gaps" in Medicare Parts A and B.)
What type of health insurance is available to assist low-income individuals? - answer Medicaid
What types of reserves are set aside and held by health insurance companies? - answer
Premium and Claims reserves (Explanation:Reserves are set aside for the payment of future
claims.)
Group health insurance is generally written on a basis that provides for dividends or experience
rating. What is the basis called? - answer Participating (Explanation:Group plans written by
mutual companies provide for dividends while stock companies frequently issue experience-
rated plans.)
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,CLASSROOM CLASSROOM CLASSROOM
Which of the following is NOT TRUE regarding eligibility for subsidies for families under the new
health care act?
-For those who make between 100-400% of the Federal Poverty -Level
-Cannot be covered by an employer
-Cannot be eligible for Medicare
-Can be eligible for Medicaid - answer Can be eligible for Medicaid
Which of the following operates as a corporation, society, or association to provide life
insurance primarily for the mutual benefit of its members, has a lodge or social system with
rituals and representative form of government?
A) Mutual companies
B) Fraternal associations
C) Stock companies
-Fraternal benefit society - answer B) Fraternal associations
What does each member pay in a typical HMO plan?
-Fixed premium based on a deductible and copay
-Fixed premium whether or not plan is used
-Premium based on how often plan is used - answer Fixed premium whether or not plan is used
Which of the following is correct about those who are eligible for Medicare and wish to join an
HMO?
-They must have a current Medicare supplement policy
-They must be told that'll be getting all the benefits from the Medicare Advantage plan
-They must be age 70 and above
-They must have been enrolled previously in an HMO - answer They must be told that'll be
getting all the benefits from the Medicare Advantage plan
CLASSROOM CLASSROOM CLASSROOM
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Joyce is totally disabled. Her HMO policy just terminated. All of the following are correct
regarding "extension of benefits" for Joyce, EXCEPT?
-Coverage ends once maximum benefits have been exhausted
-Coverage ends once another carrier assumes coverage
-Coverage ends if no longer totally disabled
-Coverage ends after 18 months - answer Coverage ends after 18 months
All of the following are correct regarding Florida regulation of HMOs, EXCEPT?
-Must obtain a Certificate of Authority
-Must file a report of its activities within 3 months of the end of each fiscal year
-Must deposit $100,000 with the Rehabilitation Administration Expense Fund
-Must be sold by agents licensed and appointed as health insurance agents - answer Must
deposit $100,000 with the Rehabilitation Administration Expense Fund (Explanation:
They must deposit $10,000 with the Rehabilitation Administration Expense Fund.)
What is "capitation" as it relates to an HMO?
-Amount to be collected by the HMO from participating health care providers
-Fixed amount paid by an HMO during a policy period
-Fixed amount paid by an HMO to a physician for medical services
-Amount required to be deposited with the State of Florida - answer Fixed amount paid by an
HMO to a physician for medical services
When a person is covered by an HMO, the contract certificate or member's handbook must be
delivered within how many days after approval of the enrollment by the HMO?
-20 days
-10 days
-5 days
-14 days - answer 10 days
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Which of the following statements about health service organizations is true?
-They reimburse Policyowners directly for physicians' fees
-They provide loss of income benefits to Policyowners
-They reimburse Policyowners directly for all medical expenses
-They provide benefit payments directly to the hospitals and physicians providing services -
answer They provide benefit payments directly to the hospitals and physicians providing
services
What is the period of time for an HMO "open enrollment"?
-45 days during every 18-month period
-30 days during every 12-month period
-30 days during every 18-month period
-45 days during every 12-month period - answer 30 days during every 18-month period
If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can be
charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000 - answer Up to $200,00
Which of the following statements about Worker's Compensation laws is INCORRECT?
-Employers can purchase coverage through the state program, private insurers or can self-insure
-Worker's compensation provides benefits for work-related injuries, illness or death
-Not all states have a workers compensation law
-Basic principle is that work-related injuries are compensable by the employer without regard to
fault - answer Not all states have a workers compensation law
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