Unit 30

Question 0

The Legislature stated that the purpose of HMOs is to do all of the following EXCEPT:

(A) deliver high-quality health care
(B) provide an alternative method of health care
(C) replace the existing system of health care delivery
(D) control the escalating cost of health care

Answer 0

(C) replace the existing system of health care delivery

Question 1

HMOs are known for stressing:

(A) preventative care and early intervention
(B) state-sponsored health plans
(C) outpatient care and services
(D) coverage for government employees

Answer 1

(A) preventative care and early intervention

Question 2

Savings of the HMO system are based on all of the following EXCEPT:

(A) keeping the premium high enough to net a profit
(B) volume discounts with hospitals
(C) capitation arrangements with physicians
(D) encouraging members to see their doctors early

Answer 2

(A) keeping the premium high enough to net a profit

Question 3

All of the following are considered unfair trade practices with regard to HMOs EXCEPT:

(A) defamation
(B) misrepresentation
(C) conversion
(D) twisting

Answer 3

(C) conversion

Question 4

The written agreement between the subscriber and the HMO is called:

(A) a health care contract
(B) a health insurance policy
(C) a health maintenance agreement
(D) a health maintenance contract

Answer 4

(D) a health maintenance contract

Question 5

The term capitation means:

(A) the premium for the HMO coverage
(B) the amount paid to the physician for each member
(C) the amount of capital the HMO possesses
(D) the value of the HMO capital improvements and buildings

Answer 5

(B) the amount paid to the physician for each member

Question 6

The term co-payment means:

(A) a fixed amount per visit or per service the subscriber must pay
(B) the amount the HMO pays the subscriber if he secures service outside the service area
(C) the amount the physician receives from the HMO for each patient treated
(D) the premium the subscriber pays

Answer 6

(A) a fixed amount per visit or per service the subscriber must pay

Question 7

The Office of Insurance Regulation will NOT issue a Certificate of Authority to an HMO until it has:

(A) 500 prospective members
(B) deposited capital and surplus int he amount of $1 million
(C) received a valid Health Care Provider Certificate from the Agency for Health Care Administration of Florida
(D) been inspected and approved by the Florida Medical Association

Answer 7

(C) received a valid Health Care Provider Certificate from the Agency for Health Care Administration of Florida

Question 8

The Florida HMO Consumer Assistance Plan:

(A) helps low-income families secure HMO coverage
(B) assists consumers in understanding their HMO coverage
(C) adjudicates contested claims by subscribers against HMOs
(D) provides coverage for subscribers to HMOs that become insolvent

Answer 8

(D) provides coverage for subscribers to HMOs that become insolvent

Question 9

How often must HMOs file a report of their activities to the Office of Insurance Regulation?

(A) Every 3 years
(B) Every 3 months
(C) Within 3 months after the close of a fiscal year
(D) At the end of each calendar year

Answer 9

(C) Within 3 months after the close of a fiscal year

Question 10

Which of the following persons may solicit applications for HMO coverage?

(A) Licensed health agent
(B) Consulting actuary
(C) Company attorney
(D) Financial adviser

Answer 10

(A) Licensed health agent

Question 11

In order to sell HMO contracts, an agent must do all of the following EXCEPT:

(A) keep and renew her appointment
(B) maintain a bond of not less than $10,000
(C) abide by the Unfair Trade Practices Act
(D) obey all regulations of the Department of Financial Services

Answer 11

(B) maintain a bond of not less than $10,000

Question 12

If an agent signs up an HMO subscriber who is eligible for Medicare:

(A) Medicare will pay what the HMO does not
(B) the subscriber is disenrolled from Medicare
(C) the subscriber becomes eligible for Medicaid
(D) the subscriber can decide whether or not to keep both HMO and Medicare coverage

Answer 12

(B) the subscriber is disenrolled from Medicare

Question 13

What is the grace period for paying premiums on an HMO contract?

(A) There is a 10-day grace period
(B) There is a 30-day grace period
(C) There is a 60-day grace period
(D) There is no grace period for HMO contracts

Answer 13

(A) There is a 10-day grace period

Question 14

In what way must the Notice to Buyer be conveyed to an HMO subscriber who is eligible for Medicare?

(A) Printing, typing, or stamping the notice on the first page of the HMO contract
(B) Stamping the notice on the application
(C) Typing the notice on the first page of the application and the contract
(D) Reading the notice to the subscriber and having the subscriber sign an acknowledgment

Answer 14

(C) Typing the notice on the first page of the application and the contract

Question 15

An HMO contract must contain all of the following EXCEPT:

(A) a listing of the surgical schedules by which surgeons are paid
(B) the premium because it is subject to change
(C) the length of the grace period
(D) procedures to be followed for emergencies

Answer 15

(A) a listing of the surgical schedules by which surgeons are paid

Question 16

HMOs offering group coverage must have an open enrollment at least:

(A) once a year
(B) for 18 days every 30 months
(C) for 1 month every 3 years
(D) for 30 days every 18 months

Answer 16

(D) for 30 days every 18 months

Question 17

An individual who buys a membership in a prepaid health clinic because the premium is less than an HMO should be aware that the clinic cannot provide:

(A) outpatient service
(B) emergency care
(C) hospitalization
(D) ambulatory diagnostic services

Answer 17

(C) hospitalization