Health Insurance Florida 2-40 Practice Exam Questions #2/Answered/A+ Rated/Complete Guide 2023/2024
Health Insurance Florida 2-40 Practice Exam
Question... [Show More] s #2/Answered/A+ Rated/Complete
Guide 2023/2024
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care
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
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?
Medicaid
What types of reserves are set aside and held by health insurance companies?
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?
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
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
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
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
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
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
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
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
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
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
-45 days during every 12-month period
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
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
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
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
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
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
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
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
Multiple Employer Trust (MET)
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
$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
-$12,500
$25,000 (Explanation:
A reimbursement type policy will provide coverage for expenses incurred. In this
case that would be the total $25,000.)
Which of the following will not be covered under "Miscellaneous Expenses" of a
hospital expense policy?
-Drugs
-Lab fees
-Daily room and board
-Use of operating room
Daily room and board
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
Physician 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
$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)
Once the insured has paid a specified amount of his expenses, under the stop-loss
feature of a health insurance policy, how much will the company then pay?
-75%
-20%
-80%
-100%
100%
How will the "miscellaneous expenses" benefit be expressed in a basic health
insurance policy?
-Reasonable, usual and customary rates
-Multiple of daily room and board rate
-Approved charge per day rate
-Percentage of daily room and board rate
Multiple of daily room and board rate
Roberta has a basic hospital expense policy with a $10,000 limit for benefits,
coordinated with a major medical policy with a $500 corridor deductible and 80/20
coinsurance provision. If she incurs a loss of $20,000, how much will the insurer
pay?
-$17,600
-$18,000
-$11,900
-$2,400
$17,600 (Explanation:
Total expenses are $20,000. Basic medical will pay the first $10,000 which leaves
$10,000 remaining. Roberta will pay the first $500 of this $10,000 with $9,500
remaining. Company will now pay 80% of $9,500 or $7,600. Total company pays
will be $10,000 from the basic medical plus $7,600 from the major medical =
$17,600)
Which of the following statements is TRUE about basic hospital, medical and
surgical expense policies?
-The benefits provided are usually equal to the actual expenses incurred
-They contain high deductibles
-They usually have a stated limit for specific expenses
-Benefits are provided for loss of income
They usually have a stated limit for specific expenses
Which of the following types of insurance policies combines several types of
benefits and provides more coverage than any of the others?
-Hospital expense
-Comprehensive major medical
-Hospital indemnity
-Surgical expense
Comprehensive major medical (Explanation:
Comprehensive major medical plans cover virtually all medical expenses in a
single policy. Such as hospital, physician and surgeon, nursing care, drugs,
physical therapy, x-rays, medical supplies, etc.)
Wanda has a Major Medical policy with a flat deductible of $250, coinsurance of
80%/20% and a stop-loss of $5,000. She has a covered claim for $5,500. What will
Wanda pay?
-$1,100
-$250
-$1,300
-$4,450
$1,300 (Wanda will pay the first $250 (her deductible) and then 20% of the
remainder ($5,250, remainder amount, x .20 = $1,050. So Wanda will pay a total
amount of $1,300 ($250 deductible, plus 20% of 5,250).)
Travis has a Major Medical policy with a flat deductible of $500 and coinsurance
of 80%/20% on the next $5,000 in covered expenses with 100% coverage for any
remaining covered expenses. On an claim of $10,000, what amount will Travis
pay? [Show Less]
