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2-40 Health and Accident Insurance State Exam Prep
103 QUESTIONS WITH COMPLETE SOLUTION
Guaranteed A+ Multiple Employer Welfare Arrangement (MEWA) provides what type of benefits? Correct Ans: Insurance XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of
eligible employees that must be covered is Correct Ans: 100%
In Major Medical Expense policies, what is the intent of Stop Loss provision? Correct Ans: Limits an insured's out-of-pocket medical expenses Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this
claim? Correct Ans: $2,100
Omitting information that affects the issuance or the rate of an insurance contract is called
Correct Ans: concealment
Florida requires that coverage for newborns begins "from the moment of birth" and continues
for Correct Ans: 18 months
In order to establish a Health Reimbursement Arrangement (HRA), it MUST Correct Ans: be established by the employer Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefits has been used, or after the policy has been in effect for a
particular period of time? Correct Ans: Restoration of used benefit
Disability policies do NOT normally pay for disabilities arising from which of the following?
Correct Ans: War
According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare
Supplement applicant? Correct Ans: At the time of application
An agent selling Medicare Supplement policies must provide every applicant with a(n) Correct
Ans: Suitability form
One definition of replacement is "the act of replacing an existing insurance policy with another".
Replacement is Correct Ans: closely regulated and requires full disclosure
Who makes the legally enforceable promises in a unilateral insurance policy? Correct Ans: insurance company 1 / 2
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Which of the following acts is an agent NOT authorized to do on behalf of an insurer? Correct
Ans: Authorize claim payments
Which of the following BEST describes a Hospital Indemnity policy? Correct Ans: Coverage that pays a stated amount PER DAY of a covered hospitalization What is required in the Florida Employee Health Care Access Act? Correct Ans: Small group benefit plan are to be issued on a "guarantee-issue" basis The waiting period for a pre-existing condition under a Medicare Supplement policy may NOT go
beyond Correct Ans: 6 months
J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did
J purchase? Correct Ans: Noncancelable
What is the elimination period of an individual disability policy? Correct Ans: Time period a disabled person must wait before benefits are paid This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year Correct Ans: Family maximum deductible Under an Individual Disability policy in Florida, what is the minimum schedule of time in which
claims must be made to an insured? Correct Ans: Monthly
Under a Long Term Care policy, which benefit would be typically excluded or limited? Correct
Ans: Alcohol rehabilitation
P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim? Correct Ans: Claim will be denied A mutual insurance company and a stock insurance company have one main difference between them. What is the Major contrast? Correct Ans: Stock company is owned by its shareholders.Mutual company is owned by its policyholders.Upon reaching the limiting age, a handicapped child can extend their health insurance coverage as a dependent Correct Ans: only if the child is incapable of employment and chiefly dependent on the policyowner Which Unfair Trade Practice involves an agent suggesting that an insurance policy is like a share
of stock? Correct Ans: Misrepresentation
Which of the following provisions is NOT required in HMO contracts/certificates? Correct Ans: Seven-day grace period As a condition for a bank loan, a bank requires the borrower to purchase credit insurance from a
specific company. What is the bank guilty of? Correct Ans: Coercion
Long Term Care policies will usually pay for eligible benefits using which of the following
methods? Correct Ans: Expense incurred
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