HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM QUESTIONS AND
CORRECT ANSWERS |2026/2027 UPDATED |GUARANTEED PASS.
Hank has medical coverage to age 70. He submits a claim for hospitalization. The insurer
discovers Hank is actually 73, when his contract states he is 68. What will the insurer do?
A) The insurer must prove fraud to be relieved from making payments.
B) The insurer must refund the excess premiums Hank paid after his 70th birthday.
C) The insurer pays what the premiums would have purchased at the correct age.
D) The insurer must pay the claim, and then cancel the contract. - Answer -The insurer must
refund the excess premiums Hank paid after his 70th birthday.
(Misstatement of Age (an Optional Uniform Provision) stipulates that since the misstatement of
age led the insurer to provide coverage beyond the age limit, liability is limited to a refund of
premiums.)
If an insurer makes a payment for a claim but you are dissatisfied, you must wait _____ days
after proof of loss before you might take any legal action.
A) 60
B) 90
C) 45
D) 20 - Answer -60
(According to the Legal Actions Provision (a Mandatory Uniform Provision), the insured must
wait at least 60 days after proof of loss before legal action can be brought against the insurer.)
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,An insurer has the right to request a physical exam or an autopsy to determine the entitlement
to benefits. The request is at the insurer's expense, due to which provision?
A) Intoxicants and Narcotics
B) Proofs of Loss
C) Physical Exam & Autopsy
D) Proof of Disability or Death - Answer -Physical Exam & Autopsy
(According to the Physical Exam and Autopsy Provision (a Mandatory Uniform Provision), the
insurer, at their own expense, has the right to request a physical exam or autopsy where not
prohibited by law.)
Susan neglected to make her premium payment and she was injured in an accident. After she
submitted the claim, she discovered that the insurer had subtracted $200 (the amount of
premiums) from the claim. The insurer may do this because of which provision?
A) Unpaid Premiums
B) Grace Period
C) Reinstatement
D) Payment of Claims - Answer -Unpaid Premiums
(Unpaid Premiums (an Optional Uniform Provision) allows the insurer the option of deducting
unpaid premiums from a claim.)
What is the correct sequence of time for the grace period on an individual medical expense
policy for each mode of premium?
A) 7 days weekly, 10 days monthly, 30 all others
B) 7 days weekly, 10 days monthly, 31 all others
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,C) 10 days weekly, 15 days monthly, 31 all others
D) 30 for individual contracts, 31 for group - Answer -7 days weekly, 10 days monthly, 31 all
others
Which of the following terms and definitions do not match?
A) Noncancellable - guaranteed renewable and guaranteed premium to age 65.
B) Optionally Renewable - renewable only at the option of the insurer.
C) Guaranteed Renewable - guaranteed renewable without proof of insurability.
D) Cancellable - the life of the policy is expressed and cannot be renewed. - Answer -Cancellable
- the life of the policy is expressed and cannot be renewed.
(The definition is defining Nonrenewable instead of Cancellable.)
Which clause in a contract states that Jim is covered by XYZ insurer for a lifetime maximum of
$1,000,000, with a schedule of benefits for various expenses?
A) Consideration Clause
B) Entire Contract
C) Free Look Provision
D) Insuring Clause - Answer -Insuring Clause
(The Insuring Clause states who is covered, by whom, for how much, and for what period,
against what peril.)
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, Abigail has a preexisting condition noted in her new A & H policy. If she submits a claim for this
condition during the probationary period, what will the insurer do?
A) Reduce the benefits paid.
B) Pay a reduced amount or deny any claim payment.
C) Pay benefits in full.
D) Provide coverage only if this claim is nonoccupational. - Answer -Pay a reduced amount or
deny any claim payment.
(Since Abigail's claim occurred during the Probationary Period, the insurer would likely deny any
claim outright or at least pay a reduced amount.)
Insurers include provisions in contracts to help reduce unnecessary claims and the overpayment
of claims. Which of the following is NOT one of those provisions?
A) Concurrent Review
B) Mandatory Second Surgical Option
C) Consideration Clause
D) Ambulatory Service - Answer -Consideration Clause
(The other choices are Case Management Provisions designed to contain costs. The
Consideration Clause stipulates that the payment of the first premium and statements in the
application are the applicant's consideration, and the insurer's consideration is the promise to
pay within the contract terms.)
A health policy not conforming to the Uniform Individual Accident and Sickness Policy Provisions
Law...
A) Is invalid.
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CORRECT ANSWERS |2026/2027 UPDATED |GUARANTEED PASS.
Hank has medical coverage to age 70. He submits a claim for hospitalization. The insurer
discovers Hank is actually 73, when his contract states he is 68. What will the insurer do?
A) The insurer must prove fraud to be relieved from making payments.
B) The insurer must refund the excess premiums Hank paid after his 70th birthday.
C) The insurer pays what the premiums would have purchased at the correct age.
D) The insurer must pay the claim, and then cancel the contract. - Answer -The insurer must
refund the excess premiums Hank paid after his 70th birthday.
(Misstatement of Age (an Optional Uniform Provision) stipulates that since the misstatement of
age led the insurer to provide coverage beyond the age limit, liability is limited to a refund of
premiums.)
If an insurer makes a payment for a claim but you are dissatisfied, you must wait _____ days
after proof of loss before you might take any legal action.
A) 60
B) 90
C) 45
D) 20 - Answer -60
(According to the Legal Actions Provision (a Mandatory Uniform Provision), the insured must
wait at least 60 days after proof of loss before legal action can be brought against the insurer.)
1|Page
,An insurer has the right to request a physical exam or an autopsy to determine the entitlement
to benefits. The request is at the insurer's expense, due to which provision?
A) Intoxicants and Narcotics
B) Proofs of Loss
C) Physical Exam & Autopsy
D) Proof of Disability or Death - Answer -Physical Exam & Autopsy
(According to the Physical Exam and Autopsy Provision (a Mandatory Uniform Provision), the
insurer, at their own expense, has the right to request a physical exam or autopsy where not
prohibited by law.)
Susan neglected to make her premium payment and she was injured in an accident. After she
submitted the claim, she discovered that the insurer had subtracted $200 (the amount of
premiums) from the claim. The insurer may do this because of which provision?
A) Unpaid Premiums
B) Grace Period
C) Reinstatement
D) Payment of Claims - Answer -Unpaid Premiums
(Unpaid Premiums (an Optional Uniform Provision) allows the insurer the option of deducting
unpaid premiums from a claim.)
What is the correct sequence of time for the grace period on an individual medical expense
policy for each mode of premium?
A) 7 days weekly, 10 days monthly, 30 all others
B) 7 days weekly, 10 days monthly, 31 all others
2|Page
,C) 10 days weekly, 15 days monthly, 31 all others
D) 30 for individual contracts, 31 for group - Answer -7 days weekly, 10 days monthly, 31 all
others
Which of the following terms and definitions do not match?
A) Noncancellable - guaranteed renewable and guaranteed premium to age 65.
B) Optionally Renewable - renewable only at the option of the insurer.
C) Guaranteed Renewable - guaranteed renewable without proof of insurability.
D) Cancellable - the life of the policy is expressed and cannot be renewed. - Answer -Cancellable
- the life of the policy is expressed and cannot be renewed.
(The definition is defining Nonrenewable instead of Cancellable.)
Which clause in a contract states that Jim is covered by XYZ insurer for a lifetime maximum of
$1,000,000, with a schedule of benefits for various expenses?
A) Consideration Clause
B) Entire Contract
C) Free Look Provision
D) Insuring Clause - Answer -Insuring Clause
(The Insuring Clause states who is covered, by whom, for how much, and for what period,
against what peril.)
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, Abigail has a preexisting condition noted in her new A & H policy. If she submits a claim for this
condition during the probationary period, what will the insurer do?
A) Reduce the benefits paid.
B) Pay a reduced amount or deny any claim payment.
C) Pay benefits in full.
D) Provide coverage only if this claim is nonoccupational. - Answer -Pay a reduced amount or
deny any claim payment.
(Since Abigail's claim occurred during the Probationary Period, the insurer would likely deny any
claim outright or at least pay a reduced amount.)
Insurers include provisions in contracts to help reduce unnecessary claims and the overpayment
of claims. Which of the following is NOT one of those provisions?
A) Concurrent Review
B) Mandatory Second Surgical Option
C) Consideration Clause
D) Ambulatory Service - Answer -Consideration Clause
(The other choices are Case Management Provisions designed to contain costs. The
Consideration Clause stipulates that the payment of the first premium and statements in the
application are the applicant's consideration, and the insurer's consideration is the promise to
pay within the contract terms.)
A health policy not conforming to the Uniform Individual Accident and Sickness Policy Provisions
Law...
A) Is invalid.
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