Florida Insurance Laws - Study Notes
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Questions and Answers

Which type of coverage is mandated in all group health insurance policies in Florida?

  • Coverage for all mental health conditions
  • Coverage for preventive services (correct)
  • Coverage for dental care
  • A pre-existing condition exclusion

    • What does 'guaranteed renewable' mean for a health insurance policy?

  • The insurer may change the terms of the policy with prior notice (correct)
  • The policy cannot be canceled unless the insured stops paying premiums
  • The insurer cannot increase premiums for any reason
  • The insurer is obligated to renew the policy at the same rate every year

    • What is the primary feature of a Medicare Advantage Plan?

  • A health plan that coordinates with Medicare to offer extra services (correct)
  • A supplement to Original Medicare that provides additional benefits
  • A long-term care insurance plan for seniors
  • A Medicaid plan for low-income individuals

    • When a health insurer goes bankrupt in Florida, what does the Florida Guaranty Fund cover?

    <p>Up to $250,000 in health claims</p> Signup and view all the answers

    What is the status of a claim after two years if an insured misrepresents their health condition?

    <p>The insurer cannot deny a claim based on misrepresentation</p> Signup and view all the answers

    What must be provided to a policyholder when they receive a life insurance policy in Florida?

    <p>Free look period</p> Signup and view all the answers

    What is true about health insurance coverage for a person with a pre-existing condition in Florida?

    <p>The insurer may impose a waiting period but cannot deny coverage.</p> Signup and view all the answers

    If a life insurance policy allows the policyholder to borrow against the cash value, this is referred to as a:

    <p>Loan option</p> Signup and view all the answers

    How will an insurer likely respond to a claim for a pre-existing condition that was not disclosed within the first two years?

    <p>Deny the claim based on the misrepresentation.</p> Signup and view all the answers

    What does the Florida Guaranty Fund cover for individual medical expenses when an insurer goes bankrupt?

    <p>Up to $250,000 in medical benefits</p> Signup and view all the answers

    If a policyholder receives a claim payment from a Florida insurer that subsequently goes bankrupt, what will the Florida Guaranty Fund provide?

    <p>Up to $300,000 for medical claims</p> Signup and view all the answers

    What must an insurer provide when a group health policy is terminated for financial reasons under Florida law?

    <p>Offer continuation of coverage at group rates</p> Signup and view all the answers

    What is a requirement for insurance agents in Florida regarding continuing education?

    <p>Participate in a state-approved continuing education program</p> Signup and view all the answers

    What is the minimum number of hours of education required for insurance agents every two years?

    <p>30 hours</p> Signup and view all the answers

    What can an insurer do if a significant misrepresentation is found after two years?

    <p>Deny the claim but keep the policy active</p> Signup and view all the answers

    Which type of policy guarantees renewal as long as premiums are paid?

    <p>Guaranteed renewable</p> Signup and view all the answers

    What is required for an insurer to cancel a health insurance policy after two years?

    <p>It cannot cancel the policy after two years</p> Signup and view all the answers

    What is the primary goal of the Florida Health Insurance Portability and Accountability Act (HIPAA)?

    <p>To maintain confidentiality of medical information</p> Signup and view all the answers

    How many employees must a small employer have to apply for group health insurance in Florida?

    <p>Two</p> Signup and view all the answers

    Which must be included in a Medicare Supplement policy in Florida?

    <p>Minimum benefit standards</p> Signup and view all the answers

    What is true when a small employer applies for a group health insurance policy?

    <p>Must cover pre-existing conditions for the entire group</p> Signup and view all the answers

    When an insurer cancels individual health insurance, what must they provide?

    <p>Written notice 45 days before cancellation</p> Signup and view all the answers

    What key provision is essential in long-term care insurance policies?

    <p>Custodial care coverage</p> Signup and view all the answers

    Which health plan allows seeking care from a non-network provider at a higher cost?

    <p>PPO</p> Signup and view all the answers

    What describes a 'Prepaid Service Organization' health plan?

    <p>Paid upfront for services before need arises</p> Signup and view all the answers

    What is true about the Florida Life and Health Insurance Guaranty Association?

    <p>Covers up to $300,000 in health claims</p> Signup and view all the answers

    When should an Outline of Coverage be provided to a prospective group health insurance policyholder?

    <p>At the time of application</p> Signup and view all the answers

    What is the maximum waiting period for excluding pre-existing conditions in Florida group health insurance?

    <p>6 months</p> Signup and view all the answers

    Study Notes

    Florida Insurance Laws - Study Notes

    • Policy Delivery Requirements: A "free look period" is required when a Florida life insurance policy is delivered to the policyholder.

    • Pre-existing Conditions (Health Insurance): Insurers in Florida cannot deny coverage for pre-existing conditions. Waiting periods are permitted, but denial based solely on the condition isn't allowed.

    • Policy Loan Options: Life insurance policies often have a "loan option" that lets policyholders borrow against the cash value.

    • Claims for Pre-existing Conditions: If a claim for a pre-existing condition is filed within the first two years, and the condition wasn't disclosed during the application, the claim will likely be denied due to misrepresentation.

    • Florida Guaranty Fund (Health Claims): If a Florida insurer goes bankrupt, the Florida Guaranty Fund covers up to $250,000 in medical benefits for an individual's claims.

    • Insurer Bankruptcy (Life Claims): In case of an insurer bankruptcy, the Florida Guaranty Fund will provide coverage for medical expenses from the policies issued in Florida, up to $300,000.

    • Group Health Policy Termination: If a group health policy is terminated due to financial reasons, the insurer must provide continuation of coverage at group rates to the eligible policyholders.

    • Insurance Agent Continuing Education: Florida insurance agents need 30 hours of continuing education every two years to maintain their licenses.

    • Misrepresentation in Life Insurance (After 2 Years): After two years, if a significant misrepresentation in a life insurance application is discovered, the insurer can deny the claim, but cannot retroactively cancel the policy.

    • Guaranteed Renewable Policies: A "guaranteed renewable" policy in health insurance means the insurer can change terms, but the contract can't be canceled.

    • Policy Cancellation After Two Years: After two years, an insurer cannot cancel a policy in Florida, based on misrepresentation discovered later.

    • HIPAA (Health Insurance Portability & Accountability Act): HIPAA focuses primarily on the confidentiality of health records and medical information, not health insurance access or cost control for Floridians in general.

    • Small Group Health Insurance: Florida allows small employers with at least two employees to apply for group health insurance.

    • Medicare Supplement Minimum Benefits: All Medicare Supplement policies in Florida must meet minimum benefit standards.

    • Small Employer Group Health Coverage: In Florida, small employers are legally obligated to provide coverage in group health plans to all employees, regardless of pre-existing conditions. Policies are meant to support the entire group.

    • Health Insurance Policy Cancellation Notice: Before canceling an insurance policy for an individual, insurers must provide a written notice to the policyholder 45 days in advance.

    • Long-Term Care Coverage: Long-term care insurance primarily covers custodial care.

    • Preferred Provider Organization (PPO) Plans: PPO plans allow the insured access to non-network healthcare providers, but at a potentially higher cost.

    • Prepaid Service Organization (PSO) Plans: In a PSO plan, medical services are typically paid upfront.

    • Florida Life and Health Insurance Guaranty Association (Limits): The Florida Life and Health Insurance Guaranty Association provides coverage up to $300,000 in case of health-related issues or claims in the event of an insurer bankruptcy.

    • Outline of Coverage (Group Health): Insurers must provide a summary of coverage at the time of application.

    • Pre-Existing Condition Exclusion Waiting Period (Group Health): The maximum waiting period permitted for pre-existing conditions in group health policies in Florida is six months.

    • HMO vs. PPO Differences: HMO plans generally limit choices of providers; PPOs offer more flexibility.

    • Waiver of Premium Riders: A waiver of premium rider typically waives premiums if the insured becomes totally disabled.

    • Prohibited Provisions (Health Insurance): Gender-based pricing, limitations for mental health coverage, are not permitted. Pre-existing conditions aren't inherently prohibited.

    • Group Health Policies (Preventive Services): Preventative health care services are required in all group health policies.

    • Guaranteed Renewable Insurance: A policy deemed "guaranteed renewable" means an insurer can still change the policy terms, and does not guarantee the same rates or continuation of benefits over time.

    • Medicare Advantage Plan: It's essentially a coordinated health insurance plan that works with Medicare. (Supplemental/alternative Medicare coverage)

    • Guaranty Fund Coverage Limits (Insurer Bankruptcy): The Guaranty Fund provides up to $250,000 in claims in Florida.

    • Misrepresentation After Two Years: For claims based on misrepresentation, an insurance company cannot cancel or deny a claim or claim payments after two years. However, they can still deny a claim based on fraud.

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    Description

    Explore the essential aspects of Florida's insurance laws in this study quiz. Understand requirements such as the free look period, coverage for pre-existing conditions, policy loan options, and implications in case of insurer bankruptcy. Perfect for students and professionals looking to reinforce their knowledge of insurance regulations.

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