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Florida Agent’s Health Insurance — Information & Free Practice

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Florida Agent’s Health Insurance

Provider
Pearson VUE
Format
Computer-based examination
Exam questions
85 scored questions plus 10 pretest questions
Time limit
2 hours
Passing score
70%
Examination outline
  • GENERAL KNOWLEDGE / I. TYPES OF POLICIES (19%)
    • A. Disability income
    • A. Disability income / 1. Individual disability income policy
    • A. Disability income / 2. Business overhead expense policy
    • A. Disability income / 3. Business disability buyout policy
    • A. Disability income / 4. Group disability income policy
    • A. Disability income / 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C. Medical expense insurance / 1. Basic hospital, medical, and surgical policies
    • C. Medical expense insurance / 2. Major medical policies
    • C. Medical expense insurance / 3. Health Maintenance Organizations (HMOs)
    • C. Medical expense insurance / 4. Preferred Provider Organizations (PPOs)
    • C. Medical expense insurance / 5. Point of Service (POS) plans
    • C. Medical expense insurance / 6. Flexible Spending Accounts (FSAs)
    • C. Medical expense insurance / 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C. Medical expense insurance / 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E. Group insurance / 1. Differences between individual and group contracts
    • E. Group insurance / 2. General characteristics
    • E. Group insurance / 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F. Individual/Group Long Term Care (LTC) / 1. Eligibility
    • F. Individual/Group Long Term Care (LTC) / 2. Levels of care
    • G. Other policies
    • G. Other policies / 1. Dental
    • G. Other policies / 2. Vision
    • G. Other policies / 3. Cancer
    • G. Other policies / 4. Critical illness or specified disease
    • G. Other policies / 5. Worksite (employer-sponsored)
    • G. Other policies / 6. Hospital indemnity
    • G. Other policies / 7. Short-term medical
    • G. Other policies / 8. Accident
  • GENERAL KNOWLEDGE / II. POLICY PROVISIONS, CLAUSES, AND RIDERS (18%)
    • A. Mandatory and optional provisions
    • A. Mandatory and optional provisions / 1. Entire contract
    • A. Mandatory and optional provisions / 2. Time limit on certain defenses (incontestable)
    • A. Mandatory and optional provisions / 3. Grace period
    • A. Mandatory and optional provisions / 4. Reinstatement
    • A. Mandatory and optional provisions / 5. Notice of claim
    • A. Mandatory and optional provisions / 6. Claim forms
    • A. Mandatory and optional provisions / 7. Proof of loss
    • A. Mandatory and optional provisions / 8. Time of payment of claims
    • A. Mandatory and optional provisions / 9. Payment of claims
    • A. Mandatory and optional provisions / 10. Physical examination and autopsy
    • A. Mandatory and optional provisions / 11. Legal actions
    • A. Mandatory and optional provisions / 12. Change of beneficiary
    • A. Mandatory and optional provisions / 13. Misstatement of age or gender
    • A. Mandatory and optional provisions / 14. Change of occupation
    • A. Mandatory and optional provisions / 15. Illegal occupation
    • A. Mandatory and optional provisions / 16. Relation of earning to insurance
    • B. Other provisions and clauses
    • B. Other provisions and clauses / 1. Insuring clause
    • B. Other provisions and clauses / 2. Free look
    • B. Other provisions and clauses / 3. Consideration clause
    • B. Other provisions and clauses / 4. Probationary period
    • B. Other provisions and clauses / 5. Elimination period
    • B. Other provisions and clauses / 6. Waiver of premium
    • B. Other provisions and clauses / 7. Exclusions and limitations
    • B. Other provisions and clauses / 8. Preexisting conditions
    • B. Other provisions and clauses / 9. Coinsurance
    • B. Other provisions and clauses / 10. Deductibles
    • B. Other provisions and clauses / 11. Eligible expenses
    • B. Other provisions and clauses / 12. Copayments
    • B. Other provisions and clauses / 13. Pre-authorizations and prior approval requirements
    • B. Other provisions and clauses / 14. Usual, reasonable, and customary (URC) charges
    • B. Other provisions and clauses / 15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C. Riders / 1. Impairment/exclusions
    • C. Riders / 2. Guaranteed insurability
    • C. Riders / 3. Future increase option
    • D. Rights of renewability
    • D. Rights of renewability / 1. Noncancelable
    • D. Rights of renewability / 2. Cancelable
    • D. Rights of renewability / 3. Guaranteed renewable
  • GENERAL KNOWLEDGE / III. SOCIAL INSURANCE (7%)
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • GENERAL KNOWLEDGE / IV. OTHER INSURANCE CONCEPTS (6%)
    • A. Total, partial, recurrent and residual disability
    • B. Owner’s rights
    • C. Dependent children benefits
    • D. Primary and contingent beneficiaries
    • E. Modes of premium payments
    • F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
    • G. Occupational vs. non-occupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • K. Subrogation
  • GENERAL KNOWLEDGE / V. FIELD UNDERWRITING PROCEDURES (9%)
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
    • D. Submitting application (and initial premium if collected) to company for underwriting
    • E. Policy delivery
    • F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • G. Replacement
    • H. Contract law
    • H. Contract law / 1. Elements of a contract
    • H. Contract law / 2. Insurable interest
    • H. Contract law / 3. Warranties and representations
    • H. Contract law / 4. Unique aspects of the insurance contract
    • H. Contract law / 4. Unique aspects of the insurance contract / a. Conditional
    • H. Contract law / 4. Unique aspects of the insurance contract / b. Unilateral
    • H. Contract law / 4. Unique aspects of the insurance contract / c. Adhesion
    • H. Contract law / 4. Unique aspects of the insurance contract / d. Aleatory
  • FLORIDA STATUTES, RULES, AND REGULATIONS / I. FLORIDA STATUTES, RULES, AND REGULATIONS COMMON TO ALL LINES (23%)
    • A. Financial Services Regulation
    • A. Financial Services Regulation / 1. Chief Financial Officer
    • A. Financial Services Regulation / 2. Financial Services Commission
    • A. Financial Services Regulation / 2. Financial Services Commission / a. Office of Financial Regulation
    • A. Financial Services Regulation / 2. Financial Services Commission / b. Office of Insurance Regulation
    • B. Department of Financial Services
    • B. Department of Financial Services / 1. General duties and powers
    • B. Department of Financial Services / 1. General duties and powers / a. Agent and adjuster licensing and investigations
    • B. Department of Financial Services / 1. General duties and powers / b. Consumer services
    • B. Department of Financial Services / 1. General duties and powers / c. Insurance Fraud
    • B. Department of Financial Services / 1. General duties and powers / d. Receivership
    • B. Department of Financial Services / 1. General duties and powers / e. Unclaimed Property
    • B. Department of Financial Services / 1. General duties and powers / f. Other powers
    • C. Office of Insurance Regulation
    • C. Office of Insurance Regulation / 1. General duties and powers
    • C. Office of Insurance Regulation / 1. General duties and powers / a. Policy approval authority
    • C. Office of Insurance Regulation / 1. General duties and powers / b. Rates and forms
    • C. Office of Insurance Regulation / 2. Market Conduct Examinations
    • C. Office of Insurance Regulation / 3. Agency Actions
    • C. Office of Insurance Regulation / 4. Investigation
    • D. Office of Financial Regulation
    • D. Office of Financial Regulation / 1. General duties and powers
    • D. Office of Financial Regulation / 2. Agency Actions
    • D. Office of Financial Regulation / 3. Investigations
    • E. Definitions
    • E. Definitions / 1. Insurance contract
    • E. Definitions / 2. Insurance transaction
    • E. Definitions / 3. Insurer
    • E. Definitions / 4. Reinsurance
    • E. Definitions / 5. Domestic company
    • E. Definitions / 6. Foreign company
    • E. Definitions / 7. Alien company
    • E. Definitions / 8. Fraternals
    • E. Definitions / 9. Authorized and unauthorized companies/admitted and non-admitted companies
    • E. Definitions / 10. Stock and mutual companies
    • E. Definitions / 11. Unlicensed entities
    • E. Definitions / 12. Certificate of authority
    • F. Licensing
    • F. Licensing / 1. Purpose
    • F. Licensing / 2. License types
    • F. Licensing / 2. License types / a. Agent
    • F. Licensing / 2. License types / b. Agency
    • F. Licensing / 3. Appointments
    • F. Licensing / 3. Appointments / a. Company
    • F. Licensing / 3. Appointments / b. Unaffiliated
    • F. Licensing / 4. License Requirements
    • F. Licensing / 4. License Requirements / a. Education
    • F. Licensing / 4. License Requirements / b. Application
    • F. Licensing / 4. License Requirements / c. Background Check
    • F. Licensing / 4. License Requirements / d. Examination
    • F. Licensing / 5. Maintaining a license
    • F. Licensing / 5. Maintaining a license / a. Continuing education
    • F. Licensing / 5. Maintaining a license / b. Communicating with the Department
    • F. Licensing / 5. Maintaining a license / c. Record keeping
    • F. Licensing / 5. Maintaining a license / d. Criminal and administrative actions
    • G. Agent responsibilities
    • G. Agent responsibilities / 1. Fiduciary capacity
    • G. Agent responsibilities / 1. Fiduciary capacity / a. Definition
    • G. Agent responsibilities / 1. Fiduciary capacity / b. Premium accountability
    • G. Agent responsibilities / 1. Fiduciary capacity / c. Separate account requirements
    • G. Agent responsibilities / 2. Commissions and compensation / charges for extra services
    • G. Agent responsibilities / 3. Reply to DFS and/or Office of Insurance Regulation
    • G. Agent responsibilities / 4. Ethics
    • H. Insurance guaranty fund
    • I. Marketing practices
    • I. Marketing practices / 1. Unfair methods of competition
    • I. Marketing practices / 1. Unfair methods of competition / a. Sliding
    • I. Marketing practices / 1. Unfair methods of competition / b. Coercion
    • I. Marketing practices / 1. Unfair methods of competition / c. Misrepresentation
    • I. Marketing practices / 1. Unfair methods of competition / d. Defamation
    • I. Marketing practices / 1. Unfair methods of competition / e. False advertising
    • I. Marketing practices / 1. Unfair methods of competition / f. Unfair discrimination
    • I. Marketing practices / 1. Unfair methods of competition / g. Unfair claims practices
    • I. Marketing practices / 1. Unfair methods of competition / h. Fraud
    • I. Marketing practices / 1. Unfair methods of competition / i. Controlled business
    • I. Marketing practices / 1. Unfair methods of competition / j. Twisting
    • I. Marketing practices / 1. Unfair methods of competition / k. Churning
    • I. Marketing practices / 1. Unfair methods of competition / l. Rebating
    • I. Marketing practices / 1. Unfair methods of competition / m. Concealment
  • FLORIDA STATUTES, RULES, AND REGULATIONS / II. FLORIDA STATUTES, RULES, AND REGULATIONS PERTINENT TO HEALTH INSURANCE (18%)
    • A. Standard Policy Provisions and Clauses (individual and group)
    • A. Standard Policy Provisions and Clauses (individual and group) / 1. Minimum Benefit Standards
    • A. Standard Policy Provisions and Clauses (individual and group) / 1. Minimum Benefit Standards / a. Grandfathered
    • A. Standard Policy Provisions and Clauses (individual and group) / 1. Minimum Benefit Standards / b. Non-grandfathered
    • A. Standard Policy Provisions and Clauses (individual and group) / 2. Required and Optional Coverages
    • A. Standard Policy Provisions and Clauses (individual and group) / 3. Prohibited Provisions
    • B. Group Health insurance
    • B. Group Health insurance / 1. Eligible groups (employer based, fraternal, assoc. blanket)
    • B. Group Health insurance / 2. Continuation
    • B. Group Health insurance / 3. Conversion
    • B. Group Health insurance / 4. Coordination of benefits
    • C. Disclosure
    • C. Disclosure / 1. Outline of Coverage
    • C. Disclosure / 2. Renewal Agreements/Nonrenewal and Cancellation
    • C. Disclosure / 3. Advertising
    • C. Disclosure / 4. Certificate of Coverage
    • C. Disclosure / 5. Group Blanket Health
    • C. Disclosure / 5. Group Blanket Health / a. Definition
    • C. Disclosure / 5. Group Blanket Health / b. Required Provisions
    • C. Disclosure / 6. Unfair Trade Practices
    • C. Disclosure / 7. Application Responsibilities
    • C. Disclosure / 8. Marketing methods and practices
    • D. Medicare Supplement Insurance
    • D. Medicare Supplement Insurance / 1. Required provisions (Minimum Standards)
    • D. Medicare Supplement Insurance / 1. Required provisions (Minimum Standards) / a. Pre-existing conditions
    • D. Medicare Supplement Insurance / 1. Required provisions (Minimum Standards) / b. Free Look
    • D. Medicare Supplement Insurance / 2. Open Enrollment Periods
    • D. Medicare Supplement Insurance / 2. Open Enrollment Periods / a. 65 and over
    • D. Medicare Supplement Insurance / 2. Open Enrollment Periods / b. under 65
    • D. Medicare Supplement Insurance / 3. Advertising
    • D. Medicare Supplement Insurance / 4. Marketing standards
    • D. Medicare Supplement Insurance / 5. Disclosure
    • D. Medicare Supplement Insurance / 5. Disclosure / a. Outline of Coverage
    • D. Medicare Supplement Insurance / 5. Disclosure / b. Buyer’s guide
    • D. Medicare Supplement Insurance / 6. Replacement/Replacement Forms
    • D. Medicare Supplement Insurance / 7. Duplication of Benefits
    • D. Medicare Supplement Insurance / 8. Standardized policy benefits (A-N)
    • D. Medicare Supplement Insurance / 9. Exclusions
    • D. Medicare Supplement Insurance / 10. Medicaid--relationship to Supplements
    • D. Medicare Supplement Insurance / 11. Medicare advantage plan
    • E. Long-term Care Policies
    • E. Long-term Care Policies / 1. Purpose
    • E. Long-term Care Policies / 2 Disclosure
    • E. Long-term Care Policies / 2 Disclosure / a. Outline of Coverage
    • E. Long-term Care Policies / 2 Disclosure / b. Buyer’s guide
    • E. Long-term Care Policies / 3. Advertising
    • E. Long-term Care Policies / 4. Policy standards
    • E. Long-term Care Policies / 5. Required Provisions (Minimum standards)
    • E. Long-term Care Policies / 6. Other Provisions
    • E. Long-term Care Policies / 7. Terminology
    • E. Long-term Care Policies / 7. Terminology / a. Skilled care
    • E. Long-term Care Policies / 7. Terminology / b. Intermediate care
    • E. Long-term Care Policies / 7. Terminology / c. Custodial care
    • E. Long-term Care Policies / 7. Terminology / d. Home health care vs. home care
    • E. Long-term Care Policies / 7. Terminology / e. Continuing care retirement communities (CCRC)
    • E. Long-term Care Policies / 7. Terminology / f. Alternate care
    • E. Long-term Care Policies / 7. Terminology / g. Case management
    • E. Long-term Care Policies / 7. Terminology / h. Activities of Daily Living (ADL’s) and cognitive impairment
    • E. Long-term Care Policies / 7. Terminology / i. Medically necessary or appropriate
    • E. Long-term Care Policies / 7. Terminology / j. Plan of care
    • E. Long-term Care Policies / 7. Terminology / k. Adult day care
    • E. Long-term Care Policies / 7. Terminology / l. Hospice care
    • E. Long-term Care Policies / 8. Replacement
    • E. Long-term Care Policies / 9. Unintentional lapse
    • E. Long-term Care Policies / 9. Unintentional lapse / a. secondary addressee
    • E. Long-term Care Policies / 9. Unintentional lapse / b. cognitive impairment
    • E. Long-term Care Policies / 10. Long-Term Care partnership
    • E. Long-term Care Policies / 11. Medicaid--relationship to Long-Term Care
    • F. Requirements for small employers
    • F. Requirements for small employers / 1. Definitions
    • F. Requirements for small employers / 2. Special Provisions
    • F. Requirements for small employers / 3. Disclosure requirements
    • F. Requirements for small employers / 4. Denial/Termination/Nonrenewal
    • F. Requirements for small employers / 5. Fair Marketing Standards
    • F. Requirements for small employers / 6. Benefit plans offered
    • F. Requirements for small employers / 7. Availability of coverage
    • F. Requirements for small employers / 8. Small Employer Rating, Renewability and Portability Act
    • F. Requirements for small employers / 9. Guaranteed issue
    • F. Requirements for small employers / 10. Employee declination of coverage
    • G. Florida Healthy Kids Corporation
    • H. Requirements relating to HIV/AIDS
    • I. Plan Types
    • I. Plan Types / 1. Health Maintenance Organization (HMO)
    • I. Plan Types / 2. Preferred Provider Organization (PPO)
    • I. Plan Types / 3. Exclusive provider organization (EPO)
    • I. Plan Types / 4. Prepaid service organization
    • I. Plan Types / 5. Indemnity plan
    • I. Plan Types / 6. Discount medical plan organization (DMPO)
    • J. Dread disease policy
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