HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM
QUESTIONS 2
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.)
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
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? - Answer -
Medicaid
What types of reserves are set aside and held by health insurance companies? -
Answer -Premium and Claims reserves (Explanation:Reserves are set aside for the
payment of future claims.)
Group health insurance is generally written on a basis that provides for dividends or
experience rating. What is the basis called? - Answer -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 - Answer -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 - Answer -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 - Answer -Fixed premium whether or not
plan is used
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 - Answer -They must be told
that'll be getting all the benefits from the Medicare Advantage plan
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
-45 days during every 12-month period - Answer -30 days during every 18-month
period
If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can
be charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000 - Answer -Up to $200,00
Which of the following statements about Worker's Compensation laws is INCORRECT?
-Employers can purchase coverage through the state program, private insurers or can
self-insure
-Worker's compensation provides benefits for work-related injuries, illness or death
-Not all states have a workers compensation law
-Basic principle is that work-related injuries are compensable by the employer without
regard to fault - Answer -Not all states have a workers compensation law
What year was the Social Security Act amended to add health insurance protection for
the aged and disabled?
-1973
-1965
-1985
-1935 - Answer -1965
,All of the following are true statements about Workers Compensation, EXCEPT..?
-Benefits are not paid unless there is employer negligence
-Pays benefits for work related injuries and illnesses
-Employee does not contribute to the plan
-All states have Workers Compensation laws - Answer -Benefits are not paid unless
there is employer negligence
Which of the following is a state administered disability plan?
-Social Security
-Workers Compensation
-Medigap
-Medicare - Answer -Workers Compensation
All of the following are nontraditional methods of providing health insurance, EXCEPT?
-Multiple Employer Trusts
-Multiple Employer Welfare Arrangements
-Self-insurance
-Commercial insurers - Answer -Commercial insurers
All of the following are true about a multiple employer welfare arrangement (MEWA),
EXCEPT?
-Required by law to have an employment-related common bond
-Often provide insurance on a self-insured basis
-Tax-exempt entities
-Large employers who have joined together to provide health insurance benefits -
Answer -Large employers who have joined together to provide health insurance benefits
(Explanation:
MEWAs consist of small employers who join together to provide health insurance
benefits for their employees)
Grouping small businesses together to obtain health insurance as one large group is a
characteristic of what type of group?
-Multiple Employer Trust (MET)
-Franchise Health plan
-Health Maintenance Organization (HMO)
-Blue Cross/Blue Shield - Answer -Multiple Employer Trust (MET)
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 - Answer -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 - Answer -
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?
-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 - Answer -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 - Answer -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 - Answer -They provide benefit payments directly to the hospitals and
physicians providing services
Casey has a medical expense policy that provides a fixed rate of $150 per day for
hospitalization. Casey is hospitalized for 10 days and incurred covered medical
expenses of $20,000. What will her medical expense policy pay?
-$1,500
-$20,000
-$15,000
-$3,000 - Answer -$1,500 (Explanation:
Casey's policy will only cover a fixed rate per day for hospitalization of $150. If she is
hospitalized for 10 days, then her policy will pay $1,500 ($150 x 10) of the total $20,000
in expenses.)
Jamie has a reimbursement type medical expense policy with a maximum benefit of
$500,000. She is hospitalized and incurs $25,000 in covered medical expenses. What
will her policy provide in coverage?
-$20,000
-$25,000
-$10,000
QUESTIONS 2
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.)
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
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? - Answer -
Medicaid
What types of reserves are set aside and held by health insurance companies? -
Answer -Premium and Claims reserves (Explanation:Reserves are set aside for the
payment of future claims.)
Group health insurance is generally written on a basis that provides for dividends or
experience rating. What is the basis called? - Answer -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 - Answer -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 - Answer -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 - Answer -Fixed premium whether or not
plan is used
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 - Answer -They must be told
that'll be getting all the benefits from the Medicare Advantage plan
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
-45 days during every 12-month period - Answer -30 days during every 18-month
period
If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can
be charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000 - Answer -Up to $200,00
Which of the following statements about Worker's Compensation laws is INCORRECT?
-Employers can purchase coverage through the state program, private insurers or can
self-insure
-Worker's compensation provides benefits for work-related injuries, illness or death
-Not all states have a workers compensation law
-Basic principle is that work-related injuries are compensable by the employer without
regard to fault - Answer -Not all states have a workers compensation law
What year was the Social Security Act amended to add health insurance protection for
the aged and disabled?
-1973
-1965
-1985
-1935 - Answer -1965
,All of the following are true statements about Workers Compensation, EXCEPT..?
-Benefits are not paid unless there is employer negligence
-Pays benefits for work related injuries and illnesses
-Employee does not contribute to the plan
-All states have Workers Compensation laws - Answer -Benefits are not paid unless
there is employer negligence
Which of the following is a state administered disability plan?
-Social Security
-Workers Compensation
-Medigap
-Medicare - Answer -Workers Compensation
All of the following are nontraditional methods of providing health insurance, EXCEPT?
-Multiple Employer Trusts
-Multiple Employer Welfare Arrangements
-Self-insurance
-Commercial insurers - Answer -Commercial insurers
All of the following are true about a multiple employer welfare arrangement (MEWA),
EXCEPT?
-Required by law to have an employment-related common bond
-Often provide insurance on a self-insured basis
-Tax-exempt entities
-Large employers who have joined together to provide health insurance benefits -
Answer -Large employers who have joined together to provide health insurance benefits
(Explanation:
MEWAs consist of small employers who join together to provide health insurance
benefits for their employees)
Grouping small businesses together to obtain health insurance as one large group is a
characteristic of what type of group?
-Multiple Employer Trust (MET)
-Franchise Health plan
-Health Maintenance Organization (HMO)
-Blue Cross/Blue Shield - Answer -Multiple Employer Trust (MET)
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 - Answer -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 - Answer -
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?
-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 - Answer -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 - Answer -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 - Answer -They provide benefit payments directly to the hospitals and
physicians providing services
Casey has a medical expense policy that provides a fixed rate of $150 per day for
hospitalization. Casey is hospitalized for 10 days and incurred covered medical
expenses of $20,000. What will her medical expense policy pay?
-$1,500
-$20,000
-$15,000
-$3,000 - Answer -$1,500 (Explanation:
Casey's policy will only cover a fixed rate per day for hospitalization of $150. If she is
hospitalized for 10 days, then her policy will pay $1,500 ($150 x 10) of the total $20,000
in expenses.)
Jamie has a reimbursement type medical expense policy with a maximum benefit of
$500,000. She is hospitalized and incurs $25,000 in covered medical expenses. What
will her policy provide in coverage?
-$20,000
-$25,000
-$10,000
