FLORIDA HEALTH INSURANCE 2-40
PRACTICE TEST BANK ACTUAL EXAM
QUESTIONS AND ANSWERS RATED A+
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?
-Social Security disability
-Medicare supplement
,-Medicare
-Medicaid - ANSWER-Medicaid
What types of reserves are set aside and held by health insurance
companies?
-Premium reserves
-Premium and Claims reserves
-Claims reserves
-Deductible and Premium reserves - 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?
-Contributory
-Noncontributory
-Nonparticipating
-Participating - 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?
• Mutual companies
• Fraternal associations
• 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 they are disenrolled from Medicare
-They must be age 70 and above
-They must have been enrolled previously in an HMO - ANSWER-
They must be told that they are disenrolled from Medicare
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
PRACTICE TEST BANK ACTUAL EXAM
QUESTIONS AND ANSWERS RATED A+
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?
-Social Security disability
-Medicare supplement
,-Medicare
-Medicaid - ANSWER-Medicaid
What types of reserves are set aside and held by health insurance
companies?
-Premium reserves
-Premium and Claims reserves
-Claims reserves
-Deductible and Premium reserves - 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?
-Contributory
-Noncontributory
-Nonparticipating
-Participating - 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?
• Mutual companies
• Fraternal associations
• 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 they are disenrolled from Medicare
-They must be age 70 and above
-They must have been enrolled previously in an HMO - ANSWER-
They must be told that they are disenrolled from Medicare
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
