HEALTH INSURANCE FLORIDA STATUTES, RULES, AND REGULATIONS EXAM
WITH COMPLETE SOLUTIONS | VERIFIED & UPDATED
"Long-Term Care policy Disclosure - Correct Answer • Must disclose renewability provisions, riders,
endorsements, limitations, or conditions of eligibility
• must define "usual and customary" or "reasonable and customary"
• Shopper's guide to applicant before completion of application
• Outline of coverage to insured before application or enrollment form"
"LTC Partnerships - Correct Answer • Insureds who have exhausted private LTC benefits may apply for
Medicaid coverage without meeting same requirements
• Disregards some or all assets of Medicaid applicants; also exempts those assets from estate recovery
after insured's death"
"Disclosure: Advertising - Correct Answer • Regulations ensure truthful and adequate disclosure of
relevant information
• Insurers maintain control over content, form and method of dissemination
• Insurers responsible for ad content"
“Minimum Benefit Standards - Contracts available in Florida - Correct Answer - Basic Medical Expense
plans
- Basic Physician's (nonsurgical) Expense plans
- Major Medical Expense plans
- Supplemental Major Medical plans
- Comprehensive Major Medical plans
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Exclusive Provider Organization (EPO) plans
- Prepaid Limited Health Service Organization plans
- Group Health Insurance plans"
"Claims Procedure - Correct Answer - Notice of Claims: submitted by insured within 20 days
- Claims forms: provided by insurer within 15 days
- Proof of loss: submitted by insured within 90 days
- Time of Payment of Claims: benefit paid immediately by insurer after proof of loss received
- Denial of Claims: if a claim was denied, the claimant has a right to appeal
- Legal Action: no sooner than 60 days, no later than 5 years
- Change of Beneficiary: beneficiary can be changed by policyowner at any time, unless irrevocable"
"Group Policies must - - Correct Answer • be Guaranteed Renewable
• cover Mental and Nervous disorders, Alcoholism and Drug dependency treatment"
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