HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM
(ACTUAL 2025) QUESTIONS & ANSWERS (VERIFIED)
There16are16three16different16approaches16used16by16insurers16in16
providing16basic16surgical16expense16coverage16and16determinin
g16the16benefits16payable.16Which16of16the16following16is16NOT16o
ne16of16these16approaches?
-Reasonable16and16customary16approach
-Physician16schedule16approach
-Relative16value16scale16approach
-Surgical16schedule16approach16-
16<<<Answers>>>Physician16schedule16approach
Charlie16has16a16hospital16expense16policy16and16a16surgical16expe
nse16policy.16The16hospital16pays16$10016a16day16for16room16and16b
oard16and16a16maximum16of16$1,00016for16miscellaneous16hospital
16charges.16The16surgical16policy16pays16a16maximum16of16$50016f
or16any16one16operation.16If16Charlie16was16hospitalized16for161016d
ays16and16had16charges16of16$20016per16day16for16room16and16board
,16$1,50016for16miscellaneous16expenses,16and16$2,00016for16surgi
cal16expenses.
What16will16his16policies16pay16of16these16expenses?
-$3,500
-$1,000
-$5,500
-$2,50016-16<<<Answers>>>$2,50016(Explanation:
Hospital16will16pay16-
16$1,00016for16room16and16board16($10016per16day16for161016days)16a
nd16$1,00016(maximum16allowed)16for
,HEALTH16INSURANCE16FLORIDA162-
4016PRACTICE16EXAM16(ACTUAL162025)16QUESTIONS16&1
6ANSWERS16(VERIFIED)
miscellaneous16expenses.16Surgical16will16pay16-
16$50016(maximum16allowed)16for16surgery)
Proof16of16loss16is16required16within16 days16of16loss.
A)1645
16 B)18
0
C) 60
D) 9016-16<<<Answers>>>90
(The16Proof16of16Loss16Provision16(a16Mandatory16Uniform16Pro
vision)16stipulates16the16insured16is16to16prove16their16loss16within1
69016days16of16the16loss,16or16in16the16shortest16time16possible,16but16
not16to16exceed16116year16unless16the16insured16suffers16legal16inca
pacity.)
Which16of16the16following16is16not16a16Mandatory16Uniform16Prov
ision?
A) Payments16of16Claims
B) Reinstatement
C) Conformity16with16State16Statutes
D) Physical16Exam16&16Autopsy16-
16<<<Answers>>>Conformity16with16State16Statutes
Harry16was16hospitalized16in16a16coma16for16616months.16Since16n
o16one16knew16about16his16health16care16coverage,16when16does16pr
oof16of16loss16have16to16be16submitted?
,A) Within16116year,16unless16he16suffers16legal16incapacity.
, HEALTH16INSURANCE16FLORIDA162-
4016PRACTICE16EXAM16(ACTUAL162025)16QUESTIONS16&1
6ANSWERS16(VERIFIED)
B) Anytime,16since16he16was16in16a16coma16and16obviously16coul
d16not16submit16a16claim.
C) Within16216years,16covered16under16the16contestable16period.
D) An16executor16would16be16appointed16by16the16courts16to16ha
ndle16the16necessary16paperwork16-
16<<<Answers>>>Within16116year,16unless16he16suffers16legal1
6incapacity.
(The16Proof16of16Loss16Provision16(a16Mandatory16Uniform16Pro
vision)16stipulates16the16insured16is16to16prove16their16loss16within1
69016days16of16the16loss,16or16in16the16shortest16time16possible,16but16
not16to16exceed16116year16unless16the16insured16suffers16legal16inca
pacity.)
Which16statement16is16INACCURATE16regarding16the16Change16o
f16Occupation16Provision?
A) Change16to16a16less16hazardous16occupation,16insured16may16a
pply16for16a16rate16reduction.
B) Change16to16a16more16hazardous16occupation,16upon16claim,
16benefits16will16be16reduced16to16that16which16premiums16paid16
would16have16purchased16at16the16more16hazardous16occupation
.
C) Insured16must16notify16the16insurer16of16a16change16of16occupa
tion,16or16policy16will16be16cancelled.
D) If16the16insured16works16at16two16occupations,16rates16for16the16
most16hazardous16occupation16will16be16charged.16-
<<<Answers>>>Insured16must16notify16the16insurer16of16a16chan
ge16of16occupation,16or16policy16will16be16cancelled.
(ACTUAL 2025) QUESTIONS & ANSWERS (VERIFIED)
There16are16three16different16approaches16used16by16insurers16in16
providing16basic16surgical16expense16coverage16and16determinin
g16the16benefits16payable.16Which16of16the16following16is16NOT16o
ne16of16these16approaches?
-Reasonable16and16customary16approach
-Physician16schedule16approach
-Relative16value16scale16approach
-Surgical16schedule16approach16-
16<<<Answers>>>Physician16schedule16approach
Charlie16has16a16hospital16expense16policy16and16a16surgical16expe
nse16policy.16The16hospital16pays16$10016a16day16for16room16and16b
oard16and16a16maximum16of16$1,00016for16miscellaneous16hospital
16charges.16The16surgical16policy16pays16a16maximum16of16$50016f
or16any16one16operation.16If16Charlie16was16hospitalized16for161016d
ays16and16had16charges16of16$20016per16day16for16room16and16board
,16$1,50016for16miscellaneous16expenses,16and16$2,00016for16surgi
cal16expenses.
What16will16his16policies16pay16of16these16expenses?
-$3,500
-$1,000
-$5,500
-$2,50016-16<<<Answers>>>$2,50016(Explanation:
Hospital16will16pay16-
16$1,00016for16room16and16board16($10016per16day16for161016days)16a
nd16$1,00016(maximum16allowed)16for
,HEALTH16INSURANCE16FLORIDA162-
4016PRACTICE16EXAM16(ACTUAL162025)16QUESTIONS16&1
6ANSWERS16(VERIFIED)
miscellaneous16expenses.16Surgical16will16pay16-
16$50016(maximum16allowed)16for16surgery)
Proof16of16loss16is16required16within16 days16of16loss.
A)1645
16 B)18
0
C) 60
D) 9016-16<<<Answers>>>90
(The16Proof16of16Loss16Provision16(a16Mandatory16Uniform16Pro
vision)16stipulates16the16insured16is16to16prove16their16loss16within1
69016days16of16the16loss,16or16in16the16shortest16time16possible,16but16
not16to16exceed16116year16unless16the16insured16suffers16legal16inca
pacity.)
Which16of16the16following16is16not16a16Mandatory16Uniform16Prov
ision?
A) Payments16of16Claims
B) Reinstatement
C) Conformity16with16State16Statutes
D) Physical16Exam16&16Autopsy16-
16<<<Answers>>>Conformity16with16State16Statutes
Harry16was16hospitalized16in16a16coma16for16616months.16Since16n
o16one16knew16about16his16health16care16coverage,16when16does16pr
oof16of16loss16have16to16be16submitted?
,A) Within16116year,16unless16he16suffers16legal16incapacity.
, HEALTH16INSURANCE16FLORIDA162-
4016PRACTICE16EXAM16(ACTUAL162025)16QUESTIONS16&1
6ANSWERS16(VERIFIED)
B) Anytime,16since16he16was16in16a16coma16and16obviously16coul
d16not16submit16a16claim.
C) Within16216years,16covered16under16the16contestable16period.
D) An16executor16would16be16appointed16by16the16courts16to16ha
ndle16the16necessary16paperwork16-
16<<<Answers>>>Within16116year,16unless16he16suffers16legal1
6incapacity.
(The16Proof16of16Loss16Provision16(a16Mandatory16Uniform16Pro
vision)16stipulates16the16insured16is16to16prove16their16loss16within1
69016days16of16the16loss,16or16in16the16shortest16time16possible,16but16
not16to16exceed16116year16unless16the16insured16suffers16legal16inca
pacity.)
Which16statement16is16INACCURATE16regarding16the16Change16o
f16Occupation16Provision?
A) Change16to16a16less16hazardous16occupation,16insured16may16a
pply16for16a16rate16reduction.
B) Change16to16a16more16hazardous16occupation,16upon16claim,
16benefits16will16be16reduced16to16that16which16premiums16paid16
would16have16purchased16at16the16more16hazardous16occupation
.
C) Insured16must16notify16the16insurer16of16a16change16of16occupa
tion,16or16policy16will16be16cancelled.
D) If16the16insured16works16at16two16occupations,16rates16for16the16
most16hazardous16occupation16will16be16charged.16-
<<<Answers>>>Insured16must16notify16the16insurer16of16a16chan
ge16of16occupation,16or16policy16will16be16cancelled.
