and Verified Answers | Latest Update 2026/2027 | Graded
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1. 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.)
2. 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 insur-ance policy sold by private insurance companies to fill "gaps" in
Medicare Parts A and B.)
3. What type of health insurance is available to assist low-income individu-
als?: answer- Medicaid
,4. What types of reserves are set aside and held by health insurance compa-
nies?: Premium and Claims reserves (Explanation:Reserves are set aside for the
payment of future claims.)
5. Group health insurance is generally written on a basis that provides for
dividends or experience rating. What is the basis called?: Participating (Expla-
nation:Group plans written by mutual companies provide for dividends while stock
companies frequently issue experience-rated plans.)
6. 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: B) Fraternal associations
7. 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: Can be eligible for Medicaid
,8. 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: Fixed premium whether or not plan
is used
9. Joyce is totally disabled. Her HMO policy just terminated. All of the follow-
ing 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: Coverage ends after 18 months
10. 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-
: Must deposit $100,000 with the Rehabilitation Administration Expense Fund (Ex-
planation:
They must deposit $10,000 with the Rehabilitation Administration Expense Fund.)
11. 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: Fixed amount paid
, by an HMO to a physician for medical services
12. 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