1
Health Insurance Florida 2-40 Practice Exam
Questions and Answers #2
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care - cORRECT sOLUTION 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.)
All of the following are state or federal government programs that provide health
insurance, EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap - cORRECT sOLUTION Medigap (Explanation:A Medigap policy is a
Medicare supplement insurance policy sold by private insurance companies to fill
"gaps" in Medicare Parts A and B.)
What type of health insurance is available to assist low-income individuals? -
cORRECT sOLUTION Medicaid
What types of reserves are set aside and held by health insurance companies? -
cORRECT sOLUTION Premium and Claims reserves (Explanation:Reserves are
set aside for the payment of future claims.)
, 2
Group health insurance is generally written on a basis that provides for dividends
or experience rating. What is the basis called? - cORRECT sOLUTION
Participating (Explanation:Group plans written by mutual companies provide for
dividends while stock companies frequently issue experience-rated plans.)
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 - cORRECT sOLUTION Can be eligible for
Medicaid
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 - cORRECT sOLUTION B) Fraternal associations
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 - cORRECT sOLUTION Fixed
premium whether or not plan is used
, 3
Which of the following is correct about those who are eligible for Medicare and
wish to join an HMO?
-They must have a current Medicare supplement policy
-They must be told that'll be getting all the benefits from the Medicare Advantage
plan
-They must be age 70 and above
-They must have been enrolled previously in an HMO - cORRECT sOLUTION
They must be told that'll be getting all the benefits from the Medicare Advantage
plan
Joyce is totally disabled. Her HMO policy just terminated. All of the following 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 - cORRECT sOLUTION Coverage ends after 18
months
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 -
cORRECT sOLUTION Must deposit $100,000 with the Rehabilitation
Administration Expense Fund (Explanation:
They must deposit $10,000 with the Rehabilitation Administration Expense Fund.)
What is "capitation" as it relates to an HMO?
, 4
-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 - cORRECT
sOLUTION Fixed amount paid by an HMO to a physician for medical services
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
-5 days
-14 days - cORRECT sOLUTION 10 days
Which of the following statements about health service organizations is true?
-They reimburse Policyowners directly for physicians' fees
-They provide loss of income benefits to Policyowners
-They reimburse Policyowners directly for all medical expenses
-They provide benefit payments directly to the hospitals and physicians providing
services - cORRECT sOLUTION They provide benefit payments directly to the
hospitals and physicians providing services
What is the period of time for an HMO "open enrollment"?
-45 days during every 18-month period
-30 days during every 12-month period
-30 days during every 18-month period
Health Insurance Florida 2-40 Practice Exam
Questions and Answers #2
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care - cORRECT sOLUTION 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.)
All of the following are state or federal government programs that provide health
insurance, EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap - cORRECT sOLUTION Medigap (Explanation:A Medigap policy is a
Medicare supplement insurance policy sold by private insurance companies to fill
"gaps" in Medicare Parts A and B.)
What type of health insurance is available to assist low-income individuals? -
cORRECT sOLUTION Medicaid
What types of reserves are set aside and held by health insurance companies? -
cORRECT sOLUTION Premium and Claims reserves (Explanation:Reserves are
set aside for the payment of future claims.)
, 2
Group health insurance is generally written on a basis that provides for dividends
or experience rating. What is the basis called? - cORRECT sOLUTION
Participating (Explanation:Group plans written by mutual companies provide for
dividends while stock companies frequently issue experience-rated plans.)
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 - cORRECT sOLUTION Can be eligible for
Medicaid
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 - cORRECT sOLUTION B) Fraternal associations
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 - cORRECT sOLUTION Fixed
premium whether or not plan is used
, 3
Which of the following is correct about those who are eligible for Medicare and
wish to join an HMO?
-They must have a current Medicare supplement policy
-They must be told that'll be getting all the benefits from the Medicare Advantage
plan
-They must be age 70 and above
-They must have been enrolled previously in an HMO - cORRECT sOLUTION
They must be told that'll be getting all the benefits from the Medicare Advantage
plan
Joyce is totally disabled. Her HMO policy just terminated. All of the following 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 - cORRECT sOLUTION Coverage ends after 18
months
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 -
cORRECT sOLUTION Must deposit $100,000 with the Rehabilitation
Administration Expense Fund (Explanation:
They must deposit $10,000 with the Rehabilitation Administration Expense Fund.)
What is "capitation" as it relates to an HMO?
, 4
-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 - cORRECT
sOLUTION Fixed amount paid by an HMO to a physician for medical services
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
-5 days
-14 days - cORRECT sOLUTION 10 days
Which of the following statements about health service organizations is true?
-They reimburse Policyowners directly for physicians' fees
-They provide loss of income benefits to Policyowners
-They reimburse Policyowners directly for all medical expenses
-They provide benefit payments directly to the hospitals and physicians providing
services - cORRECT sOLUTION They provide benefit payments directly to the
hospitals and physicians providing services
What is the period of time for an HMO "open enrollment"?
-45 days during every 18-month period
-30 days during every 12-month period
-30 days during every 18-month period
