HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM (ACTUAL 2026/2027) QUESTIONS & CORRECT ANSWERS (VERIFIED) | NEW UPDATE | GRADED A+ | 100% PASS.

HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM (ACTUAL 2026/2027) QUESTIONS & CORRECT ANSWERS (VERIFIED) | NEW UPDATE | GRADED A+ | 100% PASS. There are three different approaches used by insurers in providing basic surgical expense coverage and determining the benefits payable. Which of the following is NOT one of these approaches? -Reasonable and customary approach -Physician schedule approach -Relative value scale approach -Surgical schedule approach - AnswersPhysician schedule approach Charlie has a hospital expense policy and a surgical expense policy. The hospital pays $100 a day for room and board and a maximum of $1,000 for miscellaneous hospital charges. The surgical policy pays a maximum of $500 for any one operation. If Charlie was hospitalized for 10 days and had charges of $200 per day for room and board, $1,500 for miscellaneous expenses, and $2,000 for surgical expenses. What will his policies pay of these expenses? -$3,500 -$1,000 -$5,500 -$2,500 - Answers$2,500 (Explanation: Hospital will pay - $1,000 for room and board ($100 per day for 10 days) and $1,000 (maximum allowed) for miscellaneous expenses. Surgical will pay - $500 (maximum allowed) for surgery) Proof of loss is required within _____ days of loss. A) 45 B) 180 C) 60 D) 90 - Answers90 (The Proof of Loss Provision (a Mandatory Uniform Provision) stipulates the insured is to prove their loss within 90 days of the loss, or in the shortest time possible, but not to exceed 1 year unless the insured suffers legal incapacity.) Which of the following is not a Mandatory Uniform Provision? A) Payments of Claims B) Reinstatement C) Conformity with State Statutes D) Physical Exam & Autopsy - AnswersConformity with State Statutes Which statement is INACCURATE regarding the Change of Occupation Provision? A) Change to a less hazardous occupation, insured may apply for a rate reduction. B) Change to a more hazardous occupation, upon claim, benefits will be reduced to that which premiums paid would have purchased at the more hazardous occupation. C) Insured must notify the insurer of a change of occupation, or policy will be cancelled. D) If the insured works at two occupations, rates for the most hazardous occupation will be charged. - AnswersInsured must notify the insurer of a change of occupation, or policy will be cancelled. (Failure to notify the insurer of a change of occupation will not result in cancellation of the policy.) Optional Uniform Provisions are included in the contract at the _____ option. A) Insured's B) Insurer's C) Commissioner's D) No one's option, they are regulated by statute. - AnswersInsurer's (The Optional Uniform Provisions are included at the insurer's option; however, if used they must conform to that state's Insurance Code.) If liability is denied due to the insured being intoxicated or under the influence, it is because of which provision? A) Legal Actions B) Illegal Act C) Conformity with State Statutes D) Intoxicants and Narcotics - AnswersIntoxicants and Narcotics (Intoxicants and Narcotics (an Optional Uniform Provision) allows the insurer the right to deny liability if the insured is under the influence or intoxicated at the time of loss.) Albert owns a printing business in which he, at times, prints counterfeit money. One day while processing funny money, his arm was severely damaged. His insurance will? A) Not pay since he was involved in an illegal act at the time of injury. B) Pay as he was injured on equipment normally used for legal purposes. C) This is classified as a Workers' Compensation claim. D) Will pay but will cancel his contract when he is convicted of the crime. - AnswersNot pay since he was involved in an illegal act at the time of injury. (Illegal Occupation/Act (an Optional Uniform Provision) allows the insurer the right to deny liability if the insured is injured while performing an illegal occupation or committing an illegal act.) Three years ago, Charles purchased a health policy from the QRS Company; he has purchased two additional contracts from the same insurer since. Each contract contains the Other Insurance With This Insurer Provision. What happens if Charles has a claim? A) Only one policy will pay, the premiums for the other contracts will be returned. B) Each contract will pay in direct proportion to the loss. C) Benefits are paid in full by all contracts. D) The insurer will cancel all contracts because of intent to defraud. - AnswersOnly one policy will pay, the premiums for the other contracts will be returned. (Other Insurance With This Insurer (an Optional Uniform Provision) stipulates that if the insured has more than one policy of the same type with the same insurer, the insured may elect the policy to be used, and excess premiums for the excess coverage will be returned.) Harry was hospitalized in a coma for 6 months. Since no one knew about his health care coverage, when does proof of loss have to be submitted? A) Within 1 year, unless he suffers legal incapacity. B) Anytime, since he was in a coma and obviously could not submit a claim. C) Within 2 years, covered under the contestable period. D) An executor would be appointed by the courts to handle the necessary paperwork - AnswersWithin 1 year, unless he suffers legal incapacity. (The Proof of Loss Provision (a Mandatory Uniform Provision) stipulates the insured is to prove their loss within 90 days of the loss, or in the shortest time possible, but not to exceed 1 year unless the insured suffers legal incapacity.) Louise purchased a disability policy when her salary was $4,000 a month. Later, she lost that job and her salary was reduced to $2,000 a month. Three years ago, she became selfemployed and now receives $3,500 a month. The maximum disability benefit she might expect will be based on which salary amount? A) $2,000 B) $4,000, the contract amount C) The average of her income over the life of the contract D) $3,500 - Answers$3,500 (Relations of Earnings to Insurance (a Optional Uniform Provision) establishes that disability benefits shall not exceed the monthly earnings of an insured at the time the disability commenced, or his/her average earnings for the 2 years immediately preceding a disability, whichever is greater.) If an insurer cancels a contract, a written notice must be provided within 5 to 31 days. The contract must have which of the following provisions? A) Legal Actions B) Conformity with State Statutes C) Entire Contract D) Cancellation - AnswersCancellation