Chapter 12 - Florida Statutes, Rules, and Regulations Pertinent to Health Insurance

Question 1

What is the statute of limitation on lawsuits for health insurance policies?

Answer 1

5 years

Question 2

When are HMOs required to file a report of their activities with the Department of Financial Services?

Answer 2

Within 3 months of the end of each fiscal year

Question 3

In Florida, what is the maximum fine for an HMO that is found to be involved in unfair trade practices?

Answer 3

$200,000

Question 4

What is a policy that pays benefits for the treatment of a specific condition named in the policy up to a specified maximum amount called?

Answer 4

Dread disease policy

Question 5

A long-term care insurance shopper’s guide must be provided in the format developed by whom?

Answer 5

NAIC (National Association of Insurance Commissioners)

Question 6

In order for an employee to be considered eligible for small group insurance, the employee must work at least how many hours per week?

Answer 6

25

Question 7

Are HMOs allowed to solicit health insurance?

Answer 7

No

HMOs may not engage in any services that do not fall within Florida’s definition of “comprehensive health care services”

Question 8

The Florida Health Insurance Coverage Continuation Act requires insurers that sell health plans to small employers to offer in those plans a right to elect to continue coverage, without providing evidence of insurability, to employees who lose their coverage and are unable to replace it. The premium rate for this coverage may NOT exceed

Answer 8

115% of the regular group rate

Question 9

If an insurance company offers Medicare supplement policies, it must offer which Medicare plans?

Answer 9

A and C

Question 10

After an insurer stops offering health insurance for small employers in this state, how long must the insurer wait before selling small employer insurance in the market again?

Answer 10

5 years

Question 11

Any health insurance policy that provides coverage for maternity care must also cover the services of what three options?

Answer 11

• Certified nurse-midwives
• Midwives
• Services of licensed birth centers

Question 12

What type of group would most likely be covered under a blanket accident policy?

Answer 12

Those groups that have members that are constantly changing

Question 13

In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, how many days should be allowed for payment?

Answer 13

Within 30 days of the birth

Question 14

When an applicant applies for Medicare supplement insurance, whose responsibility is it to confirm whether the applicant has an accident or sickness insurance policy in force?

Answer 14

The insurer’s

Question 15

At what point must an Outline of Coverage be delivered on a standard policy?

Answer 15

At the time of application or upon delivery of the policy

Question 16

When does Medicare cover nursing home care?

Answer 16

Only if it is part of treatment for a covered illness or injury

Question 17

Health insurance policies issued in Florida may extend the limiting age for children covered under their parents policy to what age?

Answer 17

30

Question 18

HMOs that contract with outside physicians to provide health care service to their subscribers compensate those providers on what basis?

Answer 18

Capitation basis or a fixed amount per subscriber in exchange for the medical services agreed upon

Question 19

Florida regulations allow the extension of the limiting age to age 30, as long as what four conditions are met?

Answer 19

• Unmarried
• A state resident
• A student
• Not covered by another health policy

Question 20

When must an insurance company present an outline of coverage to an applicant for a Medicare supplement policy?

Answer 20

At the time of application

Question 21

When may an insurer require genetic information from an insured?

Answer 21

Never

Question 22

What is the Florida version of the Policy Summary?

Answer 22

The Outline of Coverage

Question 23

A group policy used to provide accident and health coverage on a group of persons being transported by a common carrier, without naming the insured persons individually is called

Answer 23

A blanket policy

Question 24

Can a person who purchased a Medicare supplement policy forego the pre-existing condition waiting period if they replace the policy two months later?

Answer 24

Yes

Question 25

What does the Florida Employee Health Care Access Act do?

Answer 25

It regulates group health insurance provisions provided by insurers or HMOs to small employers

Question 26

At what age do individuals become INELIGIBLE for Florida Healthy Kids coverage?

Answer 26

19

It covers kids through high school

Question 27

What Florida act was designed to ensure continued access to affordable health insurance coverage for employees of small employers, their dependents, and other qualified beneficiaries not currently protected by COBRA?

Answer 27

Florida Health Insurance Coverage Continuation Act

Question 28

Where can an insured find details about the free look period after deciding to replace their policy?

Answer 28

The Notice Regarding Replacement

Question 29

In the case of producer solicitation, at what point must a long-term care Shopper’s Guide be presented to the applicant?

Answer 29

Prior to the time of application

Question 30

In a long-term care policy, how are pre-existing condition limitations handled?

Answer 30

They must appear as a separate paragraph and be clearly labeled

Question 31

A corporation can be considered a “small group employer” if it has at least one and a maximum of how many employees?

Answer 31

50

Question 32

Health plan issuers are prevented from collecting genetic information for underwriting purposes or limited in their requests for genetic tests by

Answer 32

The Genetic Information and Nondiscrimination Act

Question 33

Under a Florida Health insurance policy, medical coverage of a newborn begins

Answer 33

At birth

Question 34

A 65-year-old enrolls for benefits under Medicare Part B and submits an application for a Medicare supplement policy two months later. What is the only reason the insurer may use to deny the application?

Answer 34

Material misrepresentation

Question 35

How long must an insurer retain an advertisement for its long-term care policies?

Answer 35

3 years

Question 36

When can a Long-Term Care policy deny a claim for losses incurred because of a pre-existing condition?

Answer 36

Within 6 months of the effective date of coverage

Question 37

For what single reason may an insurer terminate a small employer health insurance policy?

Answer 37

Non-payment of premiums

Question 38

Within how many days of the termination of the insured’s group coverage must the insured notify the insurer of the decision to convert to individual coverage?

Answer 38

31 days

Question 39

Medicare supplement policies, by law, must provide a free-look provision of how long?

Answer 39

30 days

Question 40

The inflation protection feature in long-term care policies issued in this state must provide protection for inflation at what percent annually?

Answer 40

5%

Question 41

Coverage of a newborn includes transportation costs up to what amount if medically necessary?

Answer 41

$1000

Question 42

What is the maximum elimination period in long-term care policies issued in Florida?

Answer 42

180 days

Question 43

In Florida, long-term care benefits may be triggered by inability to perform how many activities of daily living?

Answer 43

3

Question 44

What type of coverage is Workers Compensation?

Answer 44

Liability coverage

It pays those medical expenses of employees that an employer is legally liable to provide

Question 45

Before an organization can operate as an HMO in Florida, it must deposit how much with the Rehabilitation Administration Expense Fund?

Answer 45

$10,000