7 Health Insurance Underwriting
Which of the following correctly explains the actions an agent should take if a customer wants to apply for an insurance policy?
Complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company. If a customer wants to apply for an insurance policy, the agent should complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company.
Which of the following are NOT managed care organizations?
Medical Information Bureau (MIB). All of the following entities are managed care organizations [Point-of-Service plan (POS) Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) , EXCEPT MIB (Medical Information Bureau).
A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take?
Send a notice to the MIB that the applicant was declined. The MIB does not need to be notified that coverage was denied.
Which mode of payment is NOT used by health insurance policies?
Single premium. Single premium is not used when paying for health insurance policies.
Information obtained from a phone conversation to the proposed insured can be found in which of these reports?
Inspection report. An inspection report may include information obtained by a telephone call to the proposed insured.
Which of the following BEST describes how pre-admission certifications are used?
Used to prevent nonessential medical costs. Pre-admission certification is used to prevent unnecessary medical costs.
An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to
determine if the applicant is an acceptable risk by completing standard underwriting procedures. With a conditional receipt, the insurance company will complete standard underwriting procedures before making a decision about whether to insure the applicant.
Which of the following statements about the classification of applicants is INCORRECT?
substandard applicants are never declined by underwriters. A substandard risk is below the insurer's average risk guidelines. An individual can be rated substandard for a number of reasons and can even be rejected outright.
Which type of plan normally includes hospice benefits?
Managed care plans. Hospice benefits are typically included in managed care plans.
Agent J takes an application and initial premium from an applicant and sends the application and premium check to the insurance company. The insurance company returns the check back to J because the check is made out to J instead of the insurance company. What action should J take?
Return to the customer, collect a new check made out to the insurance company, and send the new check out to the insurance company. If an agent receives a check made out to them instead of the insurance company, they should return the check to the customer and collect a new check properly made out to the insurance company.
