2-40 Health Practice Quiz (100 Questions)

The primary purpose of health insurance is to,

The concept of risk pertains to the “uncertainty’ associated with losses.  What type of losses will an insurer most likely not cover? 

When a person demonstrates an indifference to their PERSONAL wellbeing, they’re deemed to be a,

If an individual were to have a drug or alcohol addiction, their behavior would deem them a,

What is the name of the STATISTICAL concept insurers use to predict the likelihood of an accidents, illnesses, or death occurring within a large random cross section of the population?

The purpose of disability INCOME Insurance is to,

HOW do employer sponsored Disability INCOME policies calculate employee benefits?

Mr. Jones is interest in obtaining Disability Income Insurance. During the application process, he tells you he has an extremely hazardous profession. You submit the application to underwriting and like you feared, he was deemed uninsurable.  What type of recommendation could you offer Mr. Jones? 

Which of the following policy types is the primary form of PURE accident coverage? 

Carla has an Accidental Means Provision on her disability income insurance policies.  She goes to Hawaii and jumps off a popular diving cliff into the surf below.  Unfortunately, she lands awkwardly and is permanently paralyzed.  Which of the following statements about Carla’s policy is true? 

Which type of health insurance reimburses policyowners a fixed amount for the cost associated with medical services and hospitalization? 

In which method of determining surgery benefits does an insurer assign points to surgical procedures, instead of a fixed dollar amount. 

In which method of determining surgery benefits does an insurer assign points to surgical procedures, instead of a fixed dollar amount. 

Which type of healthcare coverage picks up where First Dollar policy benefits leave off? 

Comprehensive Major Medical plans cover virtually all types of medical expenses under one policy. What financial strategy do these policies use to minimalize frivolous claims and keep premiums down. 

Mr. Jones has a Comprehensive Major Medical plan.  If he were to obtain services through his insurer, he’d be responsible to pay the first $500 of the procedure regardless of the procedures cost.  What type of cost sharing strategy does Mr. Jones’s plan utilize?  

Ms. Mary has a Major Medical policy.  She’s responsible for paying an initial deductible of $1,000.  After the deductible is satisfied, the insurer will pay 75% of covered expense.  Ms. Mary is liable for the remaining 25% of the bill.  The 25% Ms. Mary is required to pay is called,

Which of the following medical expense strategies provides a specified daily, weekly, or monthly payment based in the number of days the insured is hospitalized? 

Which of the following is a characteristic of Health-Maintenance Organizations? 

Which of the following is a characteristic of a Preferred Provider Organization? 

Which of the following is a characteristic of a Point-Of-Service-Plan?

Which of the following government insurance programs is designed to assist low-income and disabled individuals regardless of age? 

Which of the following government insurance programs is designed to provide hospital and medical expense insurance to individuals who are either; over 65, suffering from chronic kidney disease or currently receiving Social Security Disability Income Benefits? 

Which of the following government insurance programs is designed to provide benefits to individuals who are so mentally (OR) physically disabled they cannot perform any type of substantial/gainful employment for at least 12 months? 

Mary suffers severe injuries in an accident and as a result, her physician estimates the recovery process to take at least 15 months.  How long must Mary wait before she’ll begin receiving Social Security Disability Income Benefits? 

Mrs. Wu has a basic hospital/surgical expense policy which pays a hospitalization benefit of $60 per day (30-Day maximum) and $750 in miscellaneous charges.   While rock climbing, Mrs. Wu suffers a severe broken leg which requires surgery.  Her plan basic surgical benefits are determined on a schedule approach which assigns $550 to surgical expenses despite the typical cost for this procedure in this area is $850.   

Which of the following does NOT provide healthcare benefits? 

Which of the following is classified as a supplemental insurance policy? 

Group Health Insurance contracts are agreements between which two (2) entities? 

What is the definition of an “Natural Group”? 

When an employer (Or another eligible group) pays 100% of the insurance premium, the policy is considered,

Mr. Lang is a healthy individual with no pre-existing conditions. She works for a software company with over 500 employees.  As with most full-time employees, Mr. Lang participated in the group healthcare plan sponsored by his employer.  Through no fault of his own, the company decided to downsize and as a result, Mr. Lang was laid-off.  Since Federal Laws protect individuals who have been fired for reasons other than gross misconduct, which of the following is true.   

What type of insurance strategy is designed to help individuals of all ages who have lost their ability to remain self-sufficient in the community for a minimum of at least 90-days?  

Other than Long-Term Care insurance, what other healthcare strategies provide benefits for individuals who have lost their ability to remain self-sufficient in society and perform the basic activities of daily living?

Insurance policies which typically provide a one-time lump sum benefit if the insured were to be diagnosed with a critical illness are called,

A type of medical expense coverage which provides a specific/specified daily, weekly, or monthly payment based on the number of days the insured is hospitalized is called,

The National Association of Insurance Commissioners (NAIC) established 12 mandatory policy provisions to protect the best interest of the insured.  Which of the following policy provisions is designed to protect the insurer, not the insured? 

Which of the 12 mandatory provisions protects the policyowner by ensuring, only the terms and conditions contained within the contract are relevant to the agreement, no other conditions may be “Incorporated by Reference” and no changes can be made to the policy once it’s been issued? 

Which of the 12 Mandatory health insurance policy provisions deems the policy “incontestable” once it’s been in force for a specified period? 

How long of a Grace Period do individuals enrolled onto an Affordable Care Act qualified program have before they are canceled for non-payment of premium? 

Carla has a health insurance policy and pays her premium every month on the 1st according to contract.  Unfortunately, Carla was a victim of Identity Theft and the process of closing her accounts and reopening new uncompromised accounts took several days.  As a result, Carla paid her insurance premium 8-Days late.  Which scenario best describes how the insurer will handle Carla’s payment.    

Typically, the insured is expected to submit Proof of Loss to their insurer within 90-days.  Assuming the individual has the legal capacity to comply, what it the maximum amount of time allowed to lapse before the insurer is no longer liable for the loss? 

David the Millennial submitted proof of loss for a covered claim to his insurer. If the insurer does not pay his claim, how long must he wait before initiating legal action against them?

If an insurer and a claimant were to have a claim dispute. In Florida, how long does the claimant have to take legal action against the insurer?  

Jessie is insured by XYZ Insurance however, he misrepresented his age on his application.  Two years later after the Time Limit on Certain Defenses had expired, Jessie suffered an injury and submitted all relevant paperwork.  It was then, at the time of the claim when the insurer realized Jessie was 3 years older than he stated on his application.  How would the insurer most likely handle this issue? 

Which of the following is NOT an Optional Provision? 

The first page of a Health Insurance policy contains the insurers “Promise to Pay”.  This clause/provision stipulates the conditions which trigger benefits to be paid.  This provision is called the,

In Florida, a health insurance policy may be issued on an individual or structured to include eligible family members like a spouse or dependent children up to the age of 30.  Which of the following scenarios best describes the options available to a dependent child no longer eligible for coverage under their parent’s policy? 

The time immediately following the start of a disability when benefits are not payable is called the,

A sickness or injury which was obtained prior to the policy effective date is called,

Mary’s Disability Income policy allows her to purchase additional amounts of coverage in the future without providing evidence of insurability.  Which provision or rider below grants her this privilege? 

Ms. Carla is a healthy 50-year-old woman who works out regularly and even pays her healthcare premiums bi-annually (6-months at a time).  Despite being ahead on her payments, her insurer sent a notice stating her policy was being canceled and all advanced payment will be refunded.  Which of the following explanations best describes this scenario? 

James has a disability income policy which prohibits the insurer from increasing his premium and canceling his policy for reasons other than non-payment of premium.  What type of provision, rider, or clause, could grant James this type of ongoing protection? 

Which Part(s) of Medicare provides coverage for inpatient hospitalization, post-hospital skilled care facilities and home care? 

Jane is a Medicare beneficiary who requires hospitalization for an illness.  How many days of inpatient hospitalization is covered by her initial deductible?

Jessie is enrolled in Original Medicare. Approximately 6-months ago she suffered from an illness which required her to spend over two (2) months in the hospital.  Unfortunately, her illness has returned, and this time, the physician declared her condition terminal.  Which of the following scenarios pertaining Jessie’s benefits under Original Medicare is NOT true? 

To be eligible for Medicare Advantage, beneficiaries MUST be enrolled in; 

The Deficit Reduction Act of 2005 prohibits individuals from transferring assets for less than fair market value to qualify for Medicaid’s Long-Term Care benefits.  How far in the past are regulators allowed to look when trying to establish if assets were unlawfully liquidated? 

How long must an individual with a qualifying disability wait before they’re eligible to receive Social Security Disability Income benefits? 

Jeff has a healthcare policy with XYZ Insurance which covers his wife Mary however, their divorce is about to be final. Mary and Jeff will no longer be eligible for coverage as a “Family Members”.  Which of the following best describes Mary’s options for obtaining coverage once their divorce is final? 

The insurance term for the expected incidence of sickness or disability within a given age group during a specific period is called,

Which of the following group health insurance features is designed to prevent over-insurance and the duplication of benefits? 

Stephen has a disability income policy through his employer who pays 100% of the policy premium.  Which of the following scenarios best outlines the tax liabilities for Steven and his employer in this situation? 

Kelli’s has disability income insurance through her employer who pays 60% of the total premium leaving Kelli responsible for the remaining 40% of the premium.  Assuming Kelli was injured and received $10,000 in total benefits, how much of her benefits would be treated as taxable income? 

Managed Care Organizations (MCOs) utilize four (4) general approaches to contain cost.  These four strategies are Case Management, Ambulatory Surgery, Pre-Certification Reviews and,

The right of subrogation pertains to,

Which of the following entities operates as a non-profit and provides insurers with reliable medical history records to assist with the underwriting process? 

Which of the following best describes the consumers responsibility when providing information to an insurer on a policy application?

A statement made on an insurance application which is relied upon by the insurer to be literally true in every way is called a,

Insurance contracts are conditioned upon a specific event occurring which is why the dollar amount being exchanged may not be equal and there’s an element of chance for both parties.  This type of contract is called an, 

Insurance contracts are contracts of Adhesion.  This means,

The Chief Financial Officer is the head of the,

When a group health insurance policy is terminated, the insured employee is permitted to convert their coverage into an individual policy.  Which statement pertaining conversions is not true? 

When presenting insurance options to the public, agents are prohibited from,

If an employer participates in a Group health care policy, the insurer must present a certificate of coverage to,

Once licensed as a health insurance agent, how many hours of continuing education must the agent complete?   

In reference to recordkeeping, how long must agents retain policy information from past clients who have switched to other insurers? 

Which of the following state entities is responsible for paying policyowner claims in the event of an insurer insolvency?  

If a licensee were to receive a formal request for information from the Department of Financial Services, how many days is the agent given to deliver?  

The Department of Financial Services is headed by,

Which statement below best describes the regulatory powers associated with the Department of Financial Services, Division of Investigative and Forensic Services? 

The Financial Services Commission is,

Which of the following is not a major area of responsibility for the Office of Insurance Regulation?  

If an appointing entity were to terminate an agent appointment, how much notice must they provide the agent?  

Kelli receives treatment for a covered injury. How long does she have to request a claim form from the insurer?

How is Medicare Part-A funded?

How long must an employed individual pay FICA Payroll Tax before they are considered Fully Covered?

Who is Head of the Office of Insurance Regulations?

How many total days of skilled nursing care does Original Medicare provide?

What is the longest pre-existing exclusion a Medicare Supplement policy can impose onto a policyholder?

How often must the OIR audit the financial soundness of a NEW Domestic insurer?

Which of the following statements about Long-Term Care is NOTTrue?

Which of the following best identifies the penalties for failing to complete continuing education for two straight compliance periods?

Which of the following disability income policies pays the business expenses while the owner is disabled?

How many days of Home Health Aides are covered by Medicare Part-A?

How many standardized Medicare Supplement policies are sold in the marketplace?

When should agents deliver a policy summary to the client?

What is the process for licensees who move out of  the State of Florida?

Which of the following types of healthcare does not provide out of network services?

Which of the following deductible strategies considers the money a first dollar policy allocates toward covered healthcare expenses?