1|Page
2023 Florida 2-15 Insurance License Exam
Mastery: In-Depth Study Guide & Test Bank |
Over 350 Verified Questions for Ultimate
Preparation and A+ Success in the Florida Life,
Health, and Annuities Insurance Exam Updated
Version already graded a+
All of the following are characteristics of group health insurance plans EXCEPT
A. their benefits are more extensive than those under individual plans
B. the parties to a group health contract are the employer and the employees
C. employers may require employees to contribute to the premium payments
D. the cost of insuring an individual is less than what would be charged for comparable benefits under an
individual pla
- Correct Answer-B. The contract for coverage is between the insurance company and the employer, and a
master policy is issued to the employer.
Bill's medical expense policy states that it will pay him a flat $50 a day for each day he is hospitalized. The
policy pays benefits based on which basis?
A. reimbursement
B. indemnity
C. service
D. partial –
,2|Page
Correct Answer-B. Indemnity medical expense policies do not pay expenses or bills; they merely provide
the insured with a stated benefit amount for each day the insured is confined to a hospital as an in-
patient. The money may be used by the insured for any purpose.
After a week in the hospital, Lola receives a bill for $9,000 of covered expenses. Her major medical policy
has a $250 deductible and a 75.25 coinsurance feature. How much of the total expense will Lola's policy
cover?
A. $2,063
B. $6,063
C. $6,563
D. $8,753
- Correct Answer-C.
Responsibility for payment would be as follows:
Total expenses $9,000
Deductible Lola pays - 250
_______
Basis for insurer's payment $8,750
x .75
________
Amount insurer pays $6,563
Coinsurance Lola pays $2,187
A basic surgical expense policy that covers surgeon's fees per a schedule approach
A. bases its benefits on what is customary for a particular area
B. assigns a set of points to each surgical procedure
C. assigns a dollar amount to each surgical procedure
,3|Page
D. bases its benefits on a percentage of hospital room and board expenses
- Correct Answer-C. Under the surgical schedule method, every surgical procedure is assigned a dollar
amount by the insurer. When a claim is submitted to the insurer, the claims examiner reviews the policy to
determine what amount is payable; if the surgeon's bill is more than the allowed charge set by the insurer,
it is up to the insured to pay the surgeon the difference. If the surgeon's bill is less than the allowed
charge, the insurer will pay only the full amount billed; the claim payment will never exceed the amount
charged.
A stop-loss feature in a major medical policy specifies the maximum
A. benefit amount the policy provides each year
B. benefit amount the policy provides in a lifetime
C. amount the insured must pay in premiums
D. amount the insured must pay toward covered expenses
- Correct Answer-D. To provide a safeguard for insureds, many major medical policies contain a stop-loss
feature that limits the insured's out-of-pocket expenses. This means that once the insured has paid a
specified amount toward the insured's covered expenses - usually $1,000 to $2,000 - the company pays
100% of covered expenses after that point.
Which of the following is a standard optional provision for health policies?
A. grace period
B. physical exam and autopsy
C. change of beneficiary
D. misstatement of age
- Correct Answer-D. Misstatement of age is 1 of 11 optional policy provisions. Companies may ignore
them or use them in their policy forms.
, 4|Page
Accumulation units are converted into annuity units: - Correct Answer-at the time of annuity payout.
A group life insurance plan in which the employer pays the entire premium is known as a
________________ plan. - Correct Answer-noncontributory
If a disabled worker covered under Social Security disability benefits recovers and then is disabled again
within five years, a new waiting period is required before benefits begin again. - Correct Answer-FALSE
Robert had an accident and qualified for Social Security disability. Given the waiting period, when will
Robert begin to receive benefits?
- Correct Answer-After 5 months
The Insuring Clause includes all of the following EXCEPT the
- Correct Answer-beneficiary
Mutualization occurs when a stock company turns to a __________ company. - Correct Answer-mutual
To provide a safeguard for insureds, most major medical policies contain a ____________ feature that
limits the insured's out-of-pocket expenses.
- Correct Answer-stop-loss
In the insurance business, risk can best be defined as:
A. sharing the possibility of a loss
B. uncertainty regarding the future
C. uncertainty regarding financial loss
D. uncertainty regarding when death will occur
2023 Florida 2-15 Insurance License Exam
Mastery: In-Depth Study Guide & Test Bank |
Over 350 Verified Questions for Ultimate
Preparation and A+ Success in the Florida Life,
Health, and Annuities Insurance Exam Updated
Version already graded a+
All of the following are characteristics of group health insurance plans EXCEPT
A. their benefits are more extensive than those under individual plans
B. the parties to a group health contract are the employer and the employees
C. employers may require employees to contribute to the premium payments
D. the cost of insuring an individual is less than what would be charged for comparable benefits under an
individual pla
- Correct Answer-B. The contract for coverage is between the insurance company and the employer, and a
master policy is issued to the employer.
Bill's medical expense policy states that it will pay him a flat $50 a day for each day he is hospitalized. The
policy pays benefits based on which basis?
A. reimbursement
B. indemnity
C. service
D. partial –
,2|Page
Correct Answer-B. Indemnity medical expense policies do not pay expenses or bills; they merely provide
the insured with a stated benefit amount for each day the insured is confined to a hospital as an in-
patient. The money may be used by the insured for any purpose.
After a week in the hospital, Lola receives a bill for $9,000 of covered expenses. Her major medical policy
has a $250 deductible and a 75.25 coinsurance feature. How much of the total expense will Lola's policy
cover?
A. $2,063
B. $6,063
C. $6,563
D. $8,753
- Correct Answer-C.
Responsibility for payment would be as follows:
Total expenses $9,000
Deductible Lola pays - 250
_______
Basis for insurer's payment $8,750
x .75
________
Amount insurer pays $6,563
Coinsurance Lola pays $2,187
A basic surgical expense policy that covers surgeon's fees per a schedule approach
A. bases its benefits on what is customary for a particular area
B. assigns a set of points to each surgical procedure
C. assigns a dollar amount to each surgical procedure
,3|Page
D. bases its benefits on a percentage of hospital room and board expenses
- Correct Answer-C. Under the surgical schedule method, every surgical procedure is assigned a dollar
amount by the insurer. When a claim is submitted to the insurer, the claims examiner reviews the policy to
determine what amount is payable; if the surgeon's bill is more than the allowed charge set by the insurer,
it is up to the insured to pay the surgeon the difference. If the surgeon's bill is less than the allowed
charge, the insurer will pay only the full amount billed; the claim payment will never exceed the amount
charged.
A stop-loss feature in a major medical policy specifies the maximum
A. benefit amount the policy provides each year
B. benefit amount the policy provides in a lifetime
C. amount the insured must pay in premiums
D. amount the insured must pay toward covered expenses
- Correct Answer-D. To provide a safeguard for insureds, many major medical policies contain a stop-loss
feature that limits the insured's out-of-pocket expenses. This means that once the insured has paid a
specified amount toward the insured's covered expenses - usually $1,000 to $2,000 - the company pays
100% of covered expenses after that point.
Which of the following is a standard optional provision for health policies?
A. grace period
B. physical exam and autopsy
C. change of beneficiary
D. misstatement of age
- Correct Answer-D. Misstatement of age is 1 of 11 optional policy provisions. Companies may ignore
them or use them in their policy forms.
, 4|Page
Accumulation units are converted into annuity units: - Correct Answer-at the time of annuity payout.
A group life insurance plan in which the employer pays the entire premium is known as a
________________ plan. - Correct Answer-noncontributory
If a disabled worker covered under Social Security disability benefits recovers and then is disabled again
within five years, a new waiting period is required before benefits begin again. - Correct Answer-FALSE
Robert had an accident and qualified for Social Security disability. Given the waiting period, when will
Robert begin to receive benefits?
- Correct Answer-After 5 months
The Insuring Clause includes all of the following EXCEPT the
- Correct Answer-beneficiary
Mutualization occurs when a stock company turns to a __________ company. - Correct Answer-mutual
To provide a safeguard for insureds, most major medical policies contain a ____________ feature that
limits the insured's out-of-pocket expenses.
- Correct Answer-stop-loss
In the insurance business, risk can best be defined as:
A. sharing the possibility of a loss
B. uncertainty regarding the future
C. uncertainty regarding financial loss
D. uncertainty regarding when death will occur
