FLORIDA 2-15 INSURANCE LICENSE EXAM paper

FLORIDA 2-15 INSURANCE LICENSE EXAM paper with Correct Answers 2025 Graded A +

◉ Group Health Insurance. Answer: Issued by commercial insurers and

service organizations, provides coverage under a master contract to members of a specified group. (Mandatory maternity for group) -can be participating but rare.

◉ Medicaid. Answer: State level, purpose is to provide matching federal funds

to states for their medical public assistance plans to help needy persons, regardless of age.

◉ Medicare. Answer: 1966. Primary source for health insurance. Federal

government provides hospital and medical expense insurance protection to those age 65+, to those any age suffering from chronic kidney disease, or those who receive SS disability benefits. (10 supplements, 30 day free look)

◉ Renewability Provisions. Answer: Cancellable, Optionally Renewable, Non-

cancellable, Guaranteed Renewable (CONG)

◉ Premium Factors & Modes. Answer: Interest, expense, types of benefits, and morbidity.

◉ Claims. Answer: The amount of insurance coverage is readily determined by

the policy, and benefits are payable if the insured has died.

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◉ Contract of Reimbursement. Answer: The benefit an insured receives is not

fixed but instead is dependent on the amount of the loss.

◉ Commercial Insurance Providers. Answer: Including life insurance

companies, casualty insurance companies or mono line companies that specialize in one or more types of medical expense and disability income insurance.

◉ Debit Companies. Answer: Sell industrial policies (home service companies)

◉ Reimbursement approach. Answer: Policyowners obtain medical treatment

from whatever source they feel is most appropriate and, per the terms of their policy, submit their charges to their insurer for reimbursement.

◉ Right of Assignment. Answer: Insurance company and hospital work

directly with each other

◉ State worker's compensation programs. Answer: Provides benefits for

works who suffer from occupational injuries or illnesses.

◉ Self-Insurance. Answer: For businesses and individuals, an alternative to a

commercial or service health insurance plan. Administered by insurance companies or other organizations that are paid a fee for handling the paperwork and processing the claims - ASO or TPA

◉ Basic Medical Insurance. Answer: Limits coverage to select types of medical

care, no deductibles, no co-insurance - pay first (1st dollar). Provides benefits upfront. 2 / 4

◉ Major Medical Insurance. Answer: Can work as a supplement to a basic plan

or as a comprehensive standalone plan, more complete coverage. (Everything:

deductibles & co-insurance)

◉ Basic Hospital Expenses. Answer: Room & Board / Miscellaneous Expenses: Drugs, X-rays. Reimburses policy owners for the cost of hospital confinement or outpatient care if its provided instead of hospitalized care.

◉ Basic Surgical Expense. Answer: SAP: Surgeons, Anesthesiologist and any Post-Operative Care.

◉ Surgical Schedule. Answer: Flat-Rate, every surgical procedure is assigned a dollar amount by the insurer.

◉ Reasonable and Customary Approach. Answer: Surgical expense is

compared to what is deemed reasonable and customary for the geographical part of the country where the surgery was performed.

◉ Relative Value Scale. Answer: Similar to the surgical schedule, except

instead of a flat dollar amount being assigned to every surgical procedure, a set of points is assigned.

◉ Basic Physicians' Expense (Nonsurgical). Answer: Office visits & care by physician.

◉ Nurses' expense coverage. Answer: Limited to private duty nursing care 3 / 4

◉ Convalescent Care. Answer: Provides a maximum daily benefit for

confinement in a skilled nursing facility for a specified recovery period following discharge from a hospital.

◉ Supplementary Major Medical. Answer: Supplements a basic plan. Provides

coverage for expenses that are in excess of the dollar maximums specified in the basic policy & those expenses no longer covered.

◉ Comprehensive Major Medical. Answer: Any Doctor, stand alone plan. Cover

virtually all medical expenses.

◉ Deductibles. Answer: A stated initial dollar amount that the individual

insured is required to pay before insurance benefits are paid. (Flat, corridor, or integrated)

◉ Flat Deductible. Answer: Stated amount that the insured must pay before

policy benefits become payable. Family deductible - usually equal to 3x the individual deductible amount.

◉ Corridor Deductible. Answer: Part of a supplemental plan works in

conjunction with a basic medical expense policy. (2)

◉ Integrated Deductible. Answer: Supplemented. Integrated into the amounts

covered by the basic plan.

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