Florida Statutes — Health Insurance — practice questions

10% of the exam ≈15 real questions 19 free questions here

Florida standards for individual and group health policies, Medicare supplements, long-term care, small employer rules, Florida Healthy Kids, HIV requirements, and plan types — about 15 scored questions.

Where people lose points

• Medicare supplement free look is 30 days — double the 14 days for life policies.
• Medicare supplement open enrollment is six months beginning when the applicant is 65 and enrolled in Part B.
• HIV testing requires written informed consent and strict confidentiality.
• Long-term care policies require a secondary addressee option to protect against unintentional lapse.

Questions and answers, explained

All 10 questions above, with the correct answer and why it is correct. Everything here is on florida statutes — health insurance.

1. An employee of a 12-person Florida company resigns and wants to keep her group health coverage. Which statement is correct?

   • AShe has no continuation rights of any kind because the employer has fewer than 20 total employees
   • BFederal COBRA applies to her and gives her a full 36 months of continuation coverage
   • CHer only option is to convert to an individual policy immediately on leaving
   • DUnder Florida’s continuation act she may keep group coverage 18 months at up to 115% of the rateCorrect

   Why: Federal COBRA applies only to employers with 20 or more employees, so Florida's 'mini-COBRA' (s. 627.6692, F.S.) fills the gap for smaller groups: qualified beneficiaries may elect continuation without evidence of insurability for up to 18 months (29 months if disabled), paying no more than 115 percent of the group premium. Option A states the federal rule but ignores the Florida act — the classic trap.

   Reference FL-III.B; s. 627.6692, F.S.

2. Under s. 627.642, F.S., the outline of coverage for an individual health insurance policy must be delivered to the applicant:

   • AAt the time of application, or no later than delivery of the policyCorrect
   • BOnly if the applicant requests it in writing
   • CWithin 30 days after the policy is delivered
   • DOnly for Medicare supplement policies

   Why: Section 627.642, F.S., prohibits delivery of the policy unless an outline of coverage either was completed and delivered when the application was taken or accompanies the policy when delivered. The outline summarizes benefits, exclusions, limitations, and renewal provisions, and must state that it is only a summary — it is required for health policies generally, not just Medicare supplements.

   Reference FL-III.C; s. 627.642, F.S.

3. Which of the following is one of the activities of daily living (ADLs) commonly used to trigger long-term care insurance benefits?

   • ABathingCorrect
   • BDriving a car
   • CManaging personal finances
   • DGrocery shopping

   Why: The six ADLs are bathing, dressing, eating, toileting, transferring, and continence; a typical benefit trigger is the inability to perform a stated number of ADLs (or a severe cognitive impairment). Driving, managing money, and shopping are instrumental activities of daily living (IADLs) — related to independent living but not standard benefit triggers.

   Reference FL-III.E (LTC terminology); industry standard curriculum

4. Under Florida's Employee Health Care Access Act (s. 627.6699, F.S.), a 'small employer' is one that employed an average of how many eligible employees, and on what basis must small employer carriers issue their health benefit plans?

   • A2 to 25 employees; on a medically underwritten basis
   • BAt least 1 but not more than 50 eligible employees; on a guaranteed-issue basisCorrect
   • C1 to 100 employees; on a simplified-issue basis
   • D20 or more employees; subject to federal COBRA rules

   Why: Section 627.6699, F.S., defines a small employer as one employing an average of at least 1 but not more than 50 eligible employees, and its availability provision requires carriers to offer and issue all small employer health benefit plans on a guaranteed-issue basis to every eligible small employer with 2 to 50 eligible employees — regardless of health status, claims history, or preexisting conditions (one-employee groups are handled through a limited annual open-enrollment provision). Guaranteed issue means the employer group cannot be turned down for health reasons, though rating rules still apply.

   Reference FL-III.F; s. 627.6699, F.S.

5. An insured wants lower premiums and agrees to a plan that covers services ONLY when she uses providers in the plan's network (except emergencies), with no benefits for out-of-network care. Which plan type is this?

   • AExclusive provider organization (EPO)Correct
   • BPreferred provider organization (PPO)
   • CTraditional indemnity plan
   • DDental/discount medical plan organization (DMPO)

   Why: An EPO restricts benefits exclusively to network providers — out-of-network care is not covered except in emergencies — in exchange for lower premiums. A PPO, the closest distractor, still pays reduced benefits for out-of-network care; an indemnity plan allows any provider, and a discount plan organization is not insurance at all, merely negotiated price discounts.

   Reference FL-III.I (plan types); industry standard curriculum

6. Among Florida's standardized Medicare supplement plans A through N, standardized Plan A:

   • AContains only the basic (core) benefitsCorrect
   • BIs the most comprehensive plan available
   • CIs the only plan that has ever covered the Part B deductible
   • DMay be sold only to applicants under age 65

   Why: Under Rules 69O-156.0075 and 69O-156.0085, F.A.C., standardized Plan A consists solely of the basic core benefits, and an issuer that sells Medicare supplement coverage in Florida must make Plan A available. Option B is the closest distractor and reverses the structure: Plan A is the floor of the standardized menu, while Plan F historically offered the broadest coverage, including the Part B deductible that Plan A never covered.

   Reference FL-III.D; Rules 69O-156.0075, 69O-156.0085, F.A.C.

7. Florida's Medicare supplement marketing standards address duplication of coverage by requiring the application to:

   • AAsk about the applicant’s other health coverage and require the agent to list policies sold within the past 5 yearsCorrect
   • BLimit the applicant to owning one Medicare supplement policy and require written surrender of any other coverage already in force
   • CBe accompanied by the attending physician’s written statement that the additional coverage is medically necessary
   • DBe filed with the Agency for Health Care Administration for a duplication review before the policy may be issued

   Why: Rule 69O-156.015, F.A.C., requires application questions about existing Medicare Advantage, Medicaid, Medicare supplement, and other accident and sickness coverage, and requires the agent to list all health insurance policies sold to the applicant — those still in force and those sold in the past 5 years that are no longer in force. The companion marketing rule, 69O-156.016, F.A.C., makes the sale of unnecessary duplicate Medicare supplement coverage an unfair trade practice. Option B overstates it: Florida neither caps how many policies a person may own nor forces surrender of existing coverage. The rule targets unnecessary duplication and requires informed comparison.

   Reference FL-III.D; Rules 69O-156.015, 69O-156.016, F.A.C.

8. A Florida long-term care policyholder misses a premium. Under s. 627.94073, F.S., the insurer's notice of cancellation:

   • AMay be given the day after the premium due date, since Florida sets no waiting period for long-term care lapse notices
   • BMay not be given until 30 days after a premium is unpaid, must be mailed 30 days before cancellation, and is deemed given 5 days after mailingCorrect
   • CMust be hand-delivered by the writing agent, who signs an affidavit of delivery and returns it to the insurer within 5 days
   • DIs required only for insureds over age 80 or those the insurer knows to have a cognitive impairment on file at the time of lapse

   Why: Section 627.94073, F.S., builds in three separate protections: notice may not be given until 30 days after a premium is due and unpaid, the notice must be mailed at least 30 days before the cancellation takes effect, and the notice is deemed given 5 days after the date of mailing. Option D is wrong because the protection applies to long-term care policyholders generally, not to a particular age band — the statute pairs it with the annual secondary-addressee offer and with a 5-month reinstatement right where the lapse resulted from cognitive impairment or loss of functional capacity.

   Reference FL-III.E; s. 627.94073, F.S.

9. When must the outline of coverage be delivered for an individual long-term care policy sold face-to-face in Florida?

   • AAt the time of applicationCorrect
   • BWithin 10 days after the application is signed
   • CAt policy delivery
   • DWithin 30 days after the first premium is paid

   Why: Section 627.9407(10), F.S., requires the outline of coverage to be delivered at the time of application for an individual long-term care policy; only in a direct response solicitation may it come later, and then no later than delivery of the policy (C). Do not confuse this timing with the long-term care right to return under s. 627.9407(8), F.S., which runs 30 days from policy DELIVERY, not from application.

   Reference FL-III.E; s. 627.9407(8), (10), F.S.

10. An employee declines small employer coverage when first eligible, then asks to enroll eight months later with no qualifying event and no other coverage in the interim. Under s. 627.6699, F.S., he is:

    • AA special enrollee entitled to enroll in the plan immediately upon his request
    • BA late enrollee, who may have to wait for the plan’s annual open enrollmentCorrect
    • CPermanently barred from the plan for having declined it
    • DEligible only if he furnishes satisfactory evidence of his insurability

    Why: A "late enrollee" is an employee or dependent who requests enrollment other than during the first period in which the individual is eligible or during a statutory special enrollment period. Small employer carriers must offer an annual 30-day open enrollment period, which is the door a late enrollee comes through. Option C overstates the consequence — late enrollment status delays coverage, it does not permanently exclude the employee.

    Reference FL-III.F; s. 627.6699(3), (5), F.S.

Topics inside this domain

• Free look periods on the Florida 2-15
• Medicare and Medicare supplement rules
• Life policy provisions and clauses
• Disability income insurance
• HIV testing and consent in Florida underwriting
• Buyer's Guide and Florida free look periods

Drill other domains

• Types of Life Policies and Features (10%)
• Life Policy Riders, Provisions, Options, and Exclusions (10%)
• Life Application, Underwriting, and Policy Delivery (8%)
• Retirement and Other Life Insurance Concepts (5%)
• Types of Health Policies (11%)
• Health Policy Provisions, Clauses, and Riders (10%)

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