FL Health Agent 240 2024 Answers PDF

FL Health agent 240 | 100% Correct Answers | Verified | Latest 2024 Version written by AmazingGrace The Marketplace to Buy and Sell your Study Material At Stuvia, you will fin...

FL Health agent 240 | 100% Correct Answers | Verified | Latest 2024 Version written by AmazingGrace The Marketplace to Buy and Sell your Study Material At Stuvia, you will find the best notes, summaries, flashcards & other study material. Search for your school or uni and find the study material you need. www.stuvia.com Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material FL Health agent 240 | 100% Correct Answers | Verified | Latest 2024 Version An organization that transacts insurance only with its own members is a(n): - ✔✔Fraternal The ____________ has the power to issue rules and regulations to help enforce insurance laws. - ✔✔Commissioner, Superintendent, or Director All of the following are essential elements of a legal contract, EXCEPT: - ✔✔Representation Which of the following manufactures and sells insurance coverage in the form of insurance policies or contracts of insurance? - ✔✔Insurance companies The contract type in which only one party is legally bound to its contractual obligations after a premium is paid is a(n)_______ contract. - ✔✔Unilateral A(n)____________ is the person or entity that is covered by an insurance policy. - ✔✔Insured Fraternal insurance companies are owned by: - ✔✔Members Members of the ___________ include state and territorial insurance commissioners or regulators. - ✔✔National Association of Insurance Commissioners (NAIC) The ___________ branch writes and passes state insurance laws, or statutes, to protect the insuring public. - ✔✔Legislative For the most part, the highest authority for insurance regulation is: - ✔✔The individual states Insurable interest for life insurance is necessary only at the time of: - ✔✔Application Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Insurers that are incorporated in another state, but doing business in this state, are considered: - ✔✔Foreign Stock insurance companies are owned by: - ✔✔Stockholders When it comes to life insurance, insurable interest on one's own life is: - ✔✔Unlimited Which of the following best describes a conditional contract? - ✔✔Both parties must perform specified duties in order for the contract to be enforceable Which principle states that an insured may be reimbursed up to the amount of the actual loss? - ✔✔Indemnity What gives an insurer the authority to operate within this state? - ✔✔A Certificate of Authority Statements made on the application by the applicant that are believed to be true to the best of the applicant's knowledge are called: - ✔✔Representations The difference between a misrepresentation and a material misrepresentation is: - ✔✔Material misrepresentations are issues that affect policy issuance Under the Fair Credit Reporting Act, which of the following statements is correct? - ✔✔if an individual is denied coverage, they can request a copy of the report Dividends issued by mutual insurance companies: - ✔✔Are non-taxable refunds (returns) of unused or surplus premiums An insurer issues a policy as "other than applied for," requiring an additional premium of $100. When would an agreement come into being? - ✔✔When the applicant accepts delivery of the policy and pays the additional premium Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material An insurer which is formed under the laws of another country is a(n): - ✔✔Alien insurer The insurance industry is primarily regulated at the _________ level. - ✔✔State The State's __________ branch enforces the existing statutes that have been put in place. - ✔✔Executive A nonprofit corporation without capital stock formed solely for the benefit of its members is a: - ✔✔Fraternal benefit society A life insurance applicant's answers on the application indicate that they in good health. In fact, the applicant actually has a disease that they are not aware of. The statement on the application is considered: - ✔✔A representation The ___________ branch is responsible for interpreting and determining the constitutionality of the statutes. - ✔✔Judicial _________ refers to the jurisdiction where an insurer was formed or incorporated. - ✔✔Domicile Tom submits an application and a premium check. Six days later, the insurer issues the policy as applied for and mails it overnight to Tom's producer. Tom picks up the policy at his producer's office the next day. When did Tom's coverage begin? - ✔✔The day Tom submitted his application Insurance contracts are aleatory contracts. What does "aleatory" refer to? - ✔✔An unequal exchange of value n a legal sense, premium functions as the insured's _______. - ✔✔Consideration ___________ manufacture and sell insurance coverage in the form of policies or contracts of insurance. - ✔✔Insurers Which of the following is NOT one of the essential elements of any legal contract? - ✔✔Indemnity Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material An insurer that is authorized to do business in this state MUST be _____. - ✔✔An admitted insurer An applicant completes the application and submits it to the insurer along with a premium check. When is the applicant's offer considered accepted? - ✔✔When the insurer issues a policy The National Association of Insurance Commissioners (NAIC): - ✔✔Has no legal authority over insurance regulation It is the _________ who issues a Certificate of Authority enabling an insurer to conduct insurance business within a particular state. - ✔✔State insurance Commissioner or Director What is the correct insurance term for a statement that is guaranteed to be true? - ✔✔Warranty The essential elements of a contract are - ✔✔Offer and acceptance, consideration, competent parties, and legal purpose. An insurer NOT authorized to do business within this state is considered what type of insurer? - ✔✔Non- Admitted Which party to a health insurance contract is responsible for making the premium payments? - ✔✔Policyowner A spontaneous unforeseen and unintended event resulting in injury - ✔✔Accidental bodily injury The person who controls the policy and maintains the right to make all decisions regarding coverages - ✔✔Policyowner Individual specified in the policy who is eligible to receive benefits upon a loss suffered by the insured - ✔✔Beneficiary Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Individual covered for a loss under the policy - ✔✔Insured May include payments for disability income, medical, hospital and surgical expense reimbursement, dental expenses, accidental death and dismemberment, and long-term care expenses - ✔✔Health insurance benefits Relationship that must exist at the time of application in which an insured's sickness or injury would result in a financial or economic loss by the policyowner - ✔✔Insurable interest An illness or disease that occurs after a policy is issued - ✔✔Sickness An application for health insurance is completed by a producer and signed by the applicant. The applicant remembers information that needs to be added to the application before being submitted to the insurer and contacts the producer, who has returned to the office. - ✔✔The producer must meet with the applicant in person to update the information and have the applicant initial the changes If an incomplete application is accepted by the underwriter and a policy is issued without requesting the missing information, which of the following statements applies? - ✔✔The insurer waives its right to contest a claim based on the incomplete application If a premium is submitted with the application and a conditional receipt is issued, coverage is effective: - ✔✔The date of application, or date of a completed medical exam if required, whichever is later, as long as the policy would have been issued as applied for the primary source of underwriting information - ✔✔Application Alerts members about an insurance applicant's previous claim information - ✔✔MIB Medical Information Bureau If a premium is paid at the time of application and the policy is issued as applied, legal delivery can occur at the time of: - ✔✔Issuance of the policy Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material If a premium is not paid at the time of application, the producer will obtain which of the following at the time of policy delivery? - ✔✔Signed statement of good health potential risks of replacement of an individual health or disability insurance policy, except: - ✔✔Coverage due to an accident will be restricted for 30 days after the effective date of the policy Ultimately, insurability of an applicant is determined by the - ✔✔Insurer's home office underwriter Which of the following has primary responsibility for ensuring that the application is filled out completely? - ✔✔Producer If the insurer issues a policy after receiving an application for health insurance in which questions regarding preexisting conditions were left blank, what would be the consequence to the insured's coverage if a preexisting condition caused a claim shortly after the policy was issued? - ✔✔Coverage would be as stipulated in the policy because the company issued the policy even though the question was left blank Field underwriting is very important: - ✔✔Due to the risk of a moral hazard If an application is submitted with a question left unanswered, which of the following should occur? - ✔✔The insurer would require an answer before issuing a policy The specified period that must elapse before new coverage is effective for nonaccidental losses is known as which of the following? - ✔✔Probationary period The prior medical conditions for which the applicant has received, or should have received, medical advice or treatment within a specified period before the effective date of a policy are called: - ✔✔Pre- Existing Conditions In the event there is a policy issued and there are questions on the insurance application that went unanswered: - ✔✔It will be assumed that the insurer waived their right to have answers to those questions Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Which of the following is required to sign the application for insurance? - ✔✔Producer and the applicant Regarding HIPAA disclosures and privacy rules, before an insurer can share any medical information, the applicant must be notified of all the following, except: - ✔✔The insurer has the right to share identifiable health information with the agent The agent's primary underwriting role is: - ✔✔To make sure the application provides the proper information G applies for a policy as a standard risk after paying the initial premium. After thorough underwriting, the insurer issues the policy as a substandard risk. The issued policy represents: - ✔✔The insurer's counteroffer The Medical Information Bureau provides information to the insurer regarding the individual risk of an applicant and does not include: - ✔✔Credit score An insurance applicant must be notified prior to an insurer ordering an investigative or financial report as required by which law? - ✔✔Fair Credit Reporting Act What is the primary source of underwriting information for an individual health insurance policy? - ✔✔The application In the event a policy is delivered by an agent to the insured, and the premium payment is to be collected at the time of this delivery, normally what else must the agent obtain to make the delivery complete? - ✔✔A statement of good health A premium is paid at the time of application and a conditional receipt is issued. If the policy is issued as applied for, and assuming a medical exam has already been completed, coverage becomes effective: - ✔✔At the date of application At the time of policy delivery, the producer has been informed there is a change in the insured's health status. If the premium has not been collected, the producer should: - ✔✔Return the policy to the insurer for further underwriting Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Producer W filled out an application on client X. Before submitting the application to the insurer, W notices that there was one question left unanswered and another one was answered incorrectly based on the information provided. Since X lives over an hour away from the office, W should do which of the following? - ✔✔Make arrangements to meet X in-person to obtain the missing information and correct the incorrect response A specified period that must elapse before new coverage goes into effect for a given condition is known as which of the following? - ✔✔Probationary period If a policy is issued with a surcharge, this means that the - ✔✔Policy was issued with a higher premium due to the increased risk Which of the following is not considered an underwriting factor when determining insurability for health insurance? - ✔✔Spouse's occupation If a premium is collected at the time of the application, the producer will issue a: - ✔✔Conditional receipt Howard talks to his agent Jane about buying a critical illness policy from the XYZ insurance company to cover his wife Deborah, and naming his daughter Mary as the beneficiary in case of death. Jane told him that she would need signatures from all of the following, except: - ✔✔Mary, Beneficiaries are not required to sign. ____________ is the initial step of the total process of insuring a health risk. - ✔✔Field underwriting During the underwriting process, an underwriter was alerted that the applicant previously failed a medical exam by testing positive for marijuana while applying for a disability income policy 2 years ago. Which of the following sources provides this type of information to assist member companies when determining the eligibility of an individual risk? - ✔✔The MIB acts as an information exchange by alerting underwriters to previous claim information, adverse medical information, fraud, errors, omissions, or misrepresentations made on insurance applications. Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material If the insurer issues a health insurance policy without an initial premium, the producer must obtain a signed: - ✔✔Statement of Good Health If a premium was not submitted with the application, the producer must deliver the policy, explain the benefits, and collect the premium. The issued policy is the Offer and the premium becomes the: - ✔✔Acceptance Accident and Health Insurance provides coverage for two major categories of perils. They are: - ✔✔Accidental injury and sickness An application for health insurance includes all of the following information, except: - ✔✔Attending physician's statement Statements made on the application are considered true to the best of the applicant's knowledge and belief are considered to be: - ✔✔Representations statements of absolute truth. - ✔✔Warranties If questions are incomplete on an application and the insurer issues the policy, a claim is: - ✔✔Covered since the insurer issued the contract based on an incomplete application Which of the following documents used for underwriting can be completed by talking to the proposed insured over the phone? - ✔✔Inspection report Which of the following items does not become part of the insurance contract as defined in the entire contract clause? - ✔✔The agent's report Consumers must be made aware of all of the following in a replacement sale, except: - ✔✔The financial ratings from each rating service Accident and Health policies provide coverages for all, except: - ✔✔Workers' Compensation claims Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Edward applies for a disability insurance policy. He pays the initial premium at the time of application and receives a conditional receipt. Three days after the insurance company conducts a medical examination, but before it issues a policy, Edward suffers a stroke. Upon reviewing the results of his medical exam, the company discovers that Edward has been diagnosed with high blood pressure and atherosclerosis. Under the terms of the conditional receipt, the insurance company: - ✔✔Denies the claim because the insurer would not have issued the policy as applied for as standard or better Which of the following must be given to consumers under the provisions of the Fair Credit Reporting Act (FCRA)? - ✔✔Notice of Information Practices The __________ is the person applying for insurance coverage and is responsible for completing an application. - ✔✔Policyowner An applicant for accident and health insurance works two jobs. Which of the applicant's jobs will be used to underwrite the policy? - ✔✔The most hazardous of the two A specified period that must elapse before new coverage goes into effect for a given condition is known as which of the following? - ✔✔Probationary period The insurer's underwriter may find information about an applicant's moral character, hobbies, work and general reputation from a: - ✔✔Consumer Investigative Report A general report of the applicant's finances, character, morals, work, hobbies and other habits. It is sometimes called an Inspection Report. - ✔✔Consumer Investigative Report The terms "usual, customary, and reasonable" refer to which of the following? - ✔✔The average charge for a medical procedure, treatment, or service in a defined geographical area Managed health care plans generally refer to covered persons as ____________. - ✔✔Subscribers All of the following are differences between a PPO plan and an HMO, EXCEPT: - ✔✔It is a managed care plan Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Basic health plans provide "first dollar" coverage, which means: - ✔✔Benefits are payable starting with the first dollar of expenses incurred up to a stated maximum benefit and without a deductible When payment under a Medical Expense policy is based on the average fee charged by all doctors in a given geographical area, and the balance of any overcharges or costs of any disallowed services are the insured's responsibility, the payment is known as: - ✔✔sual, customary, reasonable (UCR) payment If an insured dies under the AD&D policy, which of the following will provide benefit payouts to the beneficiary: - ✔✔Principal sum ___________ is a cost sharing feature and is stated as a percentage of sharing between the insurer and the insured, such as 80/20. - ✔✔Coinsurance Which policy utilizes a Corridor Deductible after Basic Medical Expense Coverage benefits have been exhausted and before Major Medical benefits begin? - ✔✔Supplementary Major Medical H has an individual standalone vision plan, in addition to his health insurance. During an annual examination, it is discovered that H has cataracts. Which plan will cover the cost of the treatment for cataracts? - ✔✔Medical expense insurance Coverage of dependent children will continue under federal law until the child reaches the limiting age of: - ✔✔26 Which is NOT typically covered under HMOs? - ✔✔Private hospital rooms Upon joining an HMO, the plan will require the subscriber to select a: - ✔✔Primary Care Physician, also known as a Gatekeeper. Which of the following types of coverage has a corridor deductible? - ✔✔Supplemental major medical J purchased a policy that includes a carryover provision, common accident and family deductible. J owns a _______________ policy. - ✔✔Major Medical Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Sylvia is a participant in a Preferred Provider Organization and finds that if she opts to use a provider outside the network: - ✔✔Her PPO will pay a reduced amount with Sylvia paying the balance Which of the following is true concerning a Medical Expense Policy covering dependents? - ✔✔It will continue to cover a 25-year-old child who is habitually unemployed Which of the following is true regarding coinsurance? It is: - ✔✔Written as a percentage and paid by both the insurer and the insured X retired 6 months before becoming eligible for Medicare. To fill in the gap of coverage during the interim before enrolling in Medicare, X can purchase which of the following limited policies to cover medical expenses? - ✔✔Short-Term Medical All of the following are characteristics of traditional health insurance plans, except: - ✔✔The insured must see a network provider Which is the best description of a Limited Accident Policy? - ✔✔It provides benefits for injuries associated with specific events Accident and health insurance policy exclusions typically include all of the following, except - ✔✔Nonoccupational injuries As part of POS plans, when a subscriber stays in network, benefits will be paid as a(n): - ✔✔HMO Which Government health plan is available for military personnel? - ✔✔Tricare All of these are payment structure options, except - ✔✔Monthly Limit Which of the following causes of death is covered by an Accidental Death & Dismemberment policy? - ✔✔Commercial airline crash Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year?  Stuvia.com - The Marketplace to Buy and Sell your Study Material Hank was in the hospital last month for 2 days for which he received a check for $200. This month Hank was in the hospital for 5 days for which he received a check for $500. These checks are most likely: - ✔✔Benefit payments from a Hospital Income or Indemnity Policy Downloaded by: danielbonilla619 | [email protected] Want to earn $1.236 Distribution of this document is illegal extra per year? Powered by TCPDF (www.tcpdf.org)