Final Exam - Florida Life and Health
A 66 year-old is covered under a group health plan while employed with a business that
has 40 employees. If she injures herself while walking in the park, what coverage would
be considered primary? -- correct ans--Her group health plan.
If the employer has more than 20 employees, the group health plan generally pays first.
AryDisabilityryIncomerypolicyownerryrecentlyrysubmittedryaryclaimryforryarychronicryneckryproblemr
ythatryhasrynowryresultedryinrytotalrydisability.ryTheryoriginalryneckryinjuryryoccurredrybeforerytherya
pplicationrywasrytakenry5ryyearsryprior.ryTheryneckryinjuryrywasryneverrydisclosedrytorytheryinsurerry
atrytherytimeryofryapplication.ryHowrywillrytheryinsurerryhandlerythisryclaim?ry--rycorrectryans--
Claimrywillryberypaidryandrycoveragerywillryremainryinryforce.
Afterryarypolicyryhasrybeenryinryforceryforry2ry(sometimesry3)ryyears,ryitryentersrytheryincontestablery
period,ryinrywhichrytheryinsurerrymayrynotrydenyryaryclaimrybasedryonryinformationrynotrydisclosedry
atrytherytimeryofryapplication.
AryHospital/SurgicalryExpenserypolicyrywasrypurchasedryforryaryfamilyryofryfourryinryMarchryofry201
3.ryTherypolicyrywasryissuedrywithryary$500rydeductibleryandryarylimitryofryfourrydeductiblesryperrycal
endarryyear.ryTworyclaimsrywererypaidryinrySeptemberry2013,ryeachryincurringrymedicalryexpens
esryinryexcessryofrytherydeductible.ryTworyadditionalryclaimsrywereryfiledryinry2014,ryeachryinryexce
ssryofrytherydeductibleryamountryasrywell.ryWhatrywouldryberythisryfamily'sryout-of-
pocketrymedicalryexpensesryforry2013?ry--rycorrectryans--1,000.
Inrythisrysituation,rytheryinsured'srymaximumryout-of-
pocketryexpensesryforry2013rywouldrybery$1,000.
Aryliferyinsurancerypolicyrythatryprovidesryarypolicyownerrywithrycashryvalueryalongrywithryarylevelryf
aceryamountryisrycalledry--rycorrectryans--Wholerylife-
Wholeryliferyprovidesrytheryinsuredrywithryarycashryvalueryasrywellryasryarylevelryfaceryamount.
Aryliferyinsurancerypolicyownerrymayrysellrytheirrypolicyrytorya(n)ry_____ryinryorderrytoryreceiveryaryp
ercentageryofrytherypolicy'sryfaceryvalue.ry--rycorrectryans--viaticalrysettlementryprovider.
Toryreceiveryarypercentageryofrytherypolicyryfaceryvalue,ryanryownerryofryaryliferypolicyrymayrysellryth
erypolicyrytoryaryviaticalrysettlementryprovider.
AryliferypolicyryloanryinryFloridarycannotrychargeryaryfixedryrateryofryinterestryhigherrythanry--
rycorrectryans--Therymaximumryfixedryinterestryraterypermittedryonryaryliferypolicyryloanryisry10%.
,Arymutualryinsurancerycompanyryandryarystockryinsurancerycompanyryhaveryonerymainrydifferen
cerybetweenrythem.ryWhatryisrythisrymajorrycontrast?ry--rycorrectryans--
Stockrycompanyryisryownedrybyryitsryshareholders.ryMutualrycompanyryisryownedrybyryitsrypolicyh
olders.
Arypolicyowner'sryrightsryarerylimitedryunderrywhichrybeneficiaryrydesignation?ry--rycorrectryans--
Irrevocable.
Anryirrevocablerybeneficiaryrydesignationryrequiresrytheryconsentryandrysignatureryofrythatrynam
ry
edrybeneficiaryrybeforeryarychangeryofrybeneficiaryryoccurs.
AryprepaidryapplicationryforryindividualryDisabilityryIncomeryinsurancerywasryrecentlyrysubmittedr
ytoryanryinsurer.ryWhenrytheryinsurerryreceivedrytheryMedicalryInformationryBureaury(MIB)ryreport,
rytheryreportryshowedrythatrytheryapplicantryhadrysufferedryarystrokery18rymonthsryago,rysomething
rythatrywasrynotrydisclosedryonrytheryapplication.ryWhichryofrytheryfollowingryactionsrywouldrytheryin
surancerycompanyryNOTrytake?ry--rycorrectryans--
SendryarynoticerytorytheryMIBrythatrytheryapplicantrywasrydeclined.
TheryMIBrydoesrynotryneedrytoryberynotifiedrythatrycoveragerywasrydenied.
Submit
Aryprospectiveryinsuredrycompletesryandrysignsryanryapplicationryforryhealthryinsurancerybutryinte
ntionallyryconcealsryinformationryaboutryarypre-
existingryheartrycondition.ryTherycompanyryissuesrytherypolicy.ryTworymonthsrylater,rytheryinsure
drysuffersryaryheartryattackryandrysubmitsryaryclaim.ryWhileryprocessingrytheryclaim,rytherycompany
rydiscoversrytherypre-existingrycondition.ryInrythisrysituation,rytherycompanyrywillry--rycorrectryans--
continuerycoveragerybutryexcluderytheryheartrycondition.
Ifrytheryinsuredrydidrynotryciterytheryconditionryonrytheryapplicationryandrytheryinsurerrydidrynotryexcl
ry
uderytheryconditon,rytherypre-
existingryconditionryprovisionrystillryapplies.ryExclusionsryarerysubjectrytorythery"timerylimitryonrycer
tainrydefenses"ryprovision,ryhowever.
AryReturnryofryPremiumryliferyinsurancerypolicyryisry--rycorrectryans--
WholeryliferyandryIncreasingryterm.
ry
AryReturnryofryPremiumryliferyinsurancerypolicyryisrywholeryliferyinsurancerywithryarydeathrybenefitry
riderryofryincreasingrytermryinsuranceryequalrytorytheryamountryofrypremiumsrypaid.ryIfrytheryinsure
drydiesrywithinrytheryperiodryofryterm,rytherybeneficiaryrywillryreceiveryfaceryamountryplusrytheryvalu
eryofryallrypaidrypremiums.
Arystatementrymaderybyryanryinsuredryinryanryinsuranceryapplicationrythatrymustryberytruerytorythery
bestryofryone'sryknowledgeryandrywhichrybecomesryarypartryofrytherycontractryisryknownryasry--
rycorrectryans--
Aryrepresentationryisryarystatementrymaderybyryanryinsuredryinryanryinsuranceryapplicationrythatry
mustryberytruerytorytherybestryofryone'sryknowledgeryandrywhichrybecomesryarypartryofrytherycontract
.
, Arystockryliferyinsurancerycompanyrythatryissuesrybothryparticipatingryandrynonparticipatingrypoli
ciesryisrydoingrybusinessryonry--rycorrectryans--arymixedryplan.
Whenryarystockryliferyinsurancerycompanyryissuesrybothryparticipatingryandrynonparticipatingryp
olicies,rytherycompanyryisrydoingrybusinessryonryarymixedryplan.
Arytermryliferyinsurancerypolicyrymaturesry--rycorrectryans--
uponrytheryinsured'srydeathryduringrytherytermryofrytherypolicy.
Termryliferypoliciesrycanryonlyrymaturery(payryoutrytheryfaceryamount)ryifrydeathryoccursryduringryth
erytermryofrytherypolicy.
AccordingrytoryFloridarylaw,rywhenrymustryanryagentrydeliverrytheryOutlineryofryCoveragerytoryaryMe
dicarerySupplementryapplicant?ry--rycorrectryans--Atrytherytimeryofryapplication.
FloridaryinsurancerylawryrequiresrythatryifryaryMedicarerySupplementrypolicyryisrysold,rytheryagentry
mustrydeliverryanryOutlineryofryCoveragerytorytheryapplicantrynorylaterrythanrywhenrytheryapplicatio
nryisrytaken.
AccordingrytoryFloridarylaw,rywhichryofrytheryfollowingryinformationrydoesryNOTryneedrytoryberyobta
inedrybyryanryagentryrecommendingryanryannuityrypurchase?ry--rycorrectryans--Maritalrystatus.
Floridarylawryrequiresryanryagentrywhoryisryrecommendingrytherypurchaseryofryanryannuityrytoryaryp
ersonrytoryobtainryinformationryregardingryallryofrytheseryEXCEPTrytheryperson'srymaritalrystatus.
AccordingrytoryFloridarylaw,rywhichryofrytheryfollowingrystatementsryaccuratelyrydescribesryanryad
mittedrymailryorderryinsurancerycompany?ry--rycorrectryans--
Itrymayrysolicitryinsurancerybusinessrybyrymailrywithoutrytheryassistanceryofryarylicensedryagent
AccordingrytoryFlorida'sryrulesryonrydisclosure,ryaryliferyinsuranceryapplicantryisryexpectedrytorybery
providedrywithry--rycorrectryans--aryBuyer'sryGuideryandryPolicyrySummary
Agentsrythatryhaverybeenrylicensedryforrylessrythanrysixryyearsrymustrycompletery__ryhoursryofrycon
tinuingryeducationryeveryrytworyyears.ry--rycorrectryans--
Floridaryagentsrylicensedrylessrythanrysixryyearsryareryrequiredrytorycompletery24ryhoursryofryconti
nuingryeducation.
AllryofrytheseryareryconsideredrysourcesryofryunderwritingryinformationryaboutryanryapplicantryEX
CEPTry--rycorrectryans--RatingryServices.
AnryagentrysellingryMedicarerySupplementrypoliciesrymustryprovideryeveryryapplicantrywithrya(n)ry
--rycorrectryans--Suitabilityryform.
ryEveryryagentrysolicitingryMedicarerySupplementsrymustryprovideryarysuitabilityryform.
A 66 year-old is covered under a group health plan while employed with a business that
has 40 employees. If she injures herself while walking in the park, what coverage would
be considered primary? -- correct ans--Her group health plan.
If the employer has more than 20 employees, the group health plan generally pays first.
AryDisabilityryIncomerypolicyownerryrecentlyrysubmittedryaryclaimryforryarychronicryneckryproblemr
ythatryhasrynowryresultedryinrytotalrydisability.ryTheryoriginalryneckryinjuryryoccurredrybeforerytherya
pplicationrywasrytakenry5ryyearsryprior.ryTheryneckryinjuryrywasryneverrydisclosedrytorytheryinsurerry
atrytherytimeryofryapplication.ryHowrywillrytheryinsurerryhandlerythisryclaim?ry--rycorrectryans--
Claimrywillryberypaidryandrycoveragerywillryremainryinryforce.
Afterryarypolicyryhasrybeenryinryforceryforry2ry(sometimesry3)ryyears,ryitryentersrytheryincontestablery
period,ryinrywhichrytheryinsurerrymayrynotrydenyryaryclaimrybasedryonryinformationrynotrydisclosedry
atrytherytimeryofryapplication.
AryHospital/SurgicalryExpenserypolicyrywasrypurchasedryforryaryfamilyryofryfourryinryMarchryofry201
3.ryTherypolicyrywasryissuedrywithryary$500rydeductibleryandryarylimitryofryfourrydeductiblesryperrycal
endarryyear.ryTworyclaimsrywererypaidryinrySeptemberry2013,ryeachryincurringrymedicalryexpens
esryinryexcessryofrytherydeductible.ryTworyadditionalryclaimsrywereryfiledryinry2014,ryeachryinryexce
ssryofrytherydeductibleryamountryasrywell.ryWhatrywouldryberythisryfamily'sryout-of-
pocketrymedicalryexpensesryforry2013?ry--rycorrectryans--1,000.
Inrythisrysituation,rytheryinsured'srymaximumryout-of-
pocketryexpensesryforry2013rywouldrybery$1,000.
Aryliferyinsurancerypolicyrythatryprovidesryarypolicyownerrywithrycashryvalueryalongrywithryarylevelryf
aceryamountryisrycalledry--rycorrectryans--Wholerylife-
Wholeryliferyprovidesrytheryinsuredrywithryarycashryvalueryasrywellryasryarylevelryfaceryamount.
Aryliferyinsurancerypolicyownerrymayrysellrytheirrypolicyrytorya(n)ry_____ryinryorderrytoryreceiveryaryp
ercentageryofrytherypolicy'sryfaceryvalue.ry--rycorrectryans--viaticalrysettlementryprovider.
Toryreceiveryarypercentageryofrytherypolicyryfaceryvalue,ryanryownerryofryaryliferypolicyrymayrysellryth
erypolicyrytoryaryviaticalrysettlementryprovider.
AryliferypolicyryloanryinryFloridarycannotrychargeryaryfixedryrateryofryinterestryhigherrythanry--
rycorrectryans--Therymaximumryfixedryinterestryraterypermittedryonryaryliferypolicyryloanryisry10%.
,Arymutualryinsurancerycompanyryandryarystockryinsurancerycompanyryhaveryonerymainrydifferen
cerybetweenrythem.ryWhatryisrythisrymajorrycontrast?ry--rycorrectryans--
Stockrycompanyryisryownedrybyryitsryshareholders.ryMutualrycompanyryisryownedrybyryitsrypolicyh
olders.
Arypolicyowner'sryrightsryarerylimitedryunderrywhichrybeneficiaryrydesignation?ry--rycorrectryans--
Irrevocable.
Anryirrevocablerybeneficiaryrydesignationryrequiresrytheryconsentryandrysignatureryofrythatrynam
ry
edrybeneficiaryrybeforeryarychangeryofrybeneficiaryryoccurs.
AryprepaidryapplicationryforryindividualryDisabilityryIncomeryinsurancerywasryrecentlyrysubmittedr
ytoryanryinsurer.ryWhenrytheryinsurerryreceivedrytheryMedicalryInformationryBureaury(MIB)ryreport,
rytheryreportryshowedrythatrytheryapplicantryhadrysufferedryarystrokery18rymonthsryago,rysomething
rythatrywasrynotrydisclosedryonrytheryapplication.ryWhichryofrytheryfollowingryactionsrywouldrytheryin
surancerycompanyryNOTrytake?ry--rycorrectryans--
SendryarynoticerytorytheryMIBrythatrytheryapplicantrywasrydeclined.
TheryMIBrydoesrynotryneedrytoryberynotifiedrythatrycoveragerywasrydenied.
Submit
Aryprospectiveryinsuredrycompletesryandrysignsryanryapplicationryforryhealthryinsurancerybutryinte
ntionallyryconcealsryinformationryaboutryarypre-
existingryheartrycondition.ryTherycompanyryissuesrytherypolicy.ryTworymonthsrylater,rytheryinsure
drysuffersryaryheartryattackryandrysubmitsryaryclaim.ryWhileryprocessingrytheryclaim,rytherycompany
rydiscoversrytherypre-existingrycondition.ryInrythisrysituation,rytherycompanyrywillry--rycorrectryans--
continuerycoveragerybutryexcluderytheryheartrycondition.
Ifrytheryinsuredrydidrynotryciterytheryconditionryonrytheryapplicationryandrytheryinsurerrydidrynotryexcl
ry
uderytheryconditon,rytherypre-
existingryconditionryprovisionrystillryapplies.ryExclusionsryarerysubjectrytorythery"timerylimitryonrycer
tainrydefenses"ryprovision,ryhowever.
AryReturnryofryPremiumryliferyinsurancerypolicyryisry--rycorrectryans--
WholeryliferyandryIncreasingryterm.
ry
AryReturnryofryPremiumryliferyinsurancerypolicyryisrywholeryliferyinsurancerywithryarydeathrybenefitry
riderryofryincreasingrytermryinsuranceryequalrytorytheryamountryofrypremiumsrypaid.ryIfrytheryinsure
drydiesrywithinrytheryperiodryofryterm,rytherybeneficiaryrywillryreceiveryfaceryamountryplusrytheryvalu
eryofryallrypaidrypremiums.
Arystatementrymaderybyryanryinsuredryinryanryinsuranceryapplicationrythatrymustryberytruerytorythery
bestryofryone'sryknowledgeryandrywhichrybecomesryarypartryofrytherycontractryisryknownryasry--
rycorrectryans--
Aryrepresentationryisryarystatementrymaderybyryanryinsuredryinryanryinsuranceryapplicationrythatry
mustryberytruerytorytherybestryofryone'sryknowledgeryandrywhichrybecomesryarypartryofrytherycontract
.
, Arystockryliferyinsurancerycompanyrythatryissuesrybothryparticipatingryandrynonparticipatingrypoli
ciesryisrydoingrybusinessryonry--rycorrectryans--arymixedryplan.
Whenryarystockryliferyinsurancerycompanyryissuesrybothryparticipatingryandrynonparticipatingryp
olicies,rytherycompanyryisrydoingrybusinessryonryarymixedryplan.
Arytermryliferyinsurancerypolicyrymaturesry--rycorrectryans--
uponrytheryinsured'srydeathryduringrytherytermryofrytherypolicy.
Termryliferypoliciesrycanryonlyrymaturery(payryoutrytheryfaceryamount)ryifrydeathryoccursryduringryth
erytermryofrytherypolicy.
AccordingrytoryFloridarylaw,rywhenrymustryanryagentrydeliverrytheryOutlineryofryCoveragerytoryaryMe
dicarerySupplementryapplicant?ry--rycorrectryans--Atrytherytimeryofryapplication.
FloridaryinsurancerylawryrequiresrythatryifryaryMedicarerySupplementrypolicyryisrysold,rytheryagentry
mustrydeliverryanryOutlineryofryCoveragerytorytheryapplicantrynorylaterrythanrywhenrytheryapplicatio
nryisrytaken.
AccordingrytoryFloridarylaw,rywhichryofrytheryfollowingryinformationrydoesryNOTryneedrytoryberyobta
inedrybyryanryagentryrecommendingryanryannuityrypurchase?ry--rycorrectryans--Maritalrystatus.
Floridarylawryrequiresryanryagentrywhoryisryrecommendingrytherypurchaseryofryanryannuityrytoryaryp
ersonrytoryobtainryinformationryregardingryallryofrytheseryEXCEPTrytheryperson'srymaritalrystatus.
AccordingrytoryFloridarylaw,rywhichryofrytheryfollowingrystatementsryaccuratelyrydescribesryanryad
mittedrymailryorderryinsurancerycompany?ry--rycorrectryans--
Itrymayrysolicitryinsurancerybusinessrybyrymailrywithoutrytheryassistanceryofryarylicensedryagent
AccordingrytoryFlorida'sryrulesryonrydisclosure,ryaryliferyinsuranceryapplicantryisryexpectedrytorybery
providedrywithry--rycorrectryans--aryBuyer'sryGuideryandryPolicyrySummary
Agentsrythatryhaverybeenrylicensedryforrylessrythanrysixryyearsrymustrycompletery__ryhoursryofrycon
tinuingryeducationryeveryrytworyyears.ry--rycorrectryans--
Floridaryagentsrylicensedrylessrythanrysixryyearsryareryrequiredrytorycompletery24ryhoursryofryconti
nuingryeducation.
AllryofrytheseryareryconsideredrysourcesryofryunderwritingryinformationryaboutryanryapplicantryEX
CEPTry--rycorrectryans--RatingryServices.
AnryagentrysellingryMedicarerySupplementrypoliciesrymustryprovideryeveryryapplicantrywithrya(n)ry
--rycorrectryans--Suitabilityryform.
ryEveryryagentrysolicitingryMedicarerySupplementsrymustryprovideryarysuitabilityryform.
