West Virginia Insurance

What is the typical deductible for basic surgical expense cost?

$0

Within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained?

3 days

If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?

5 days

What is material misrepresentation?

A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company

Insurance policies are not drawn up through negotiations, and an insured has little to say about its provisions. What contract characteristics does this describe?

Adhesion

An insured pays a $100 premium every month for his insurance coverage, yet the insured promises to pay $10,000 for a covered loss. What characteristic of an insurance contract does this describe?

Aleatory

If an insurance company wishes to order a consumer report on an applicant to assist in the underwriting process and if a notice of insurance information practices has been provided the report may contain all of the following information EXCEPT the applicants

Ancestry

An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery, the agent collects the applicant's premium check, answers any questions the applicant may have, and then leaves. What did he forget to do?

Ask her to sign a statement of good health

To comply with Fair Credit Reporting Act, when must a producer notify an applicant that a credit report may be requested?

At the time of application

What document describes an insured's medical history including diagnoses and treatment

Attending Physicians Statement

All of the following can be insurers EXCEPT

Bankers

An insurance contract must contain all of the following to be considered leagally binding EXCEPT

Beneficiary's consent

An insurance contract must contain all the following to be considered legally binding EXCEPT

Beneficiary's consent

An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles had the insurer violated?

Consideration

Which of the following reports will provide the underwriter with the information about an insurance applicants credit?

Consumer report

Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as

Contracts of Adhesion

In a relative value system of determining coverage for a given procedure what teen describes the total amount payable per point?

Conversion factor

Which of the following is NOT true regarding Basic Surgical Expense coverage?

Coverage is unlimited

The insurance policy together with the policy application and any added riders form what is known as

Entire Contract

Which of the following best describes the aleatory nature of an Insurance contract?

Exchanges of unequal value

What phase begins after a new policy is delivered?

Free look period

Under the Privacy Rule for HIPPAA protected information includes all individually identified health information

Held or transmitted in any form

What is the three basic coverages for medical expense insurance?

Hospital, surgical, medical

A life insurance policy has a legal purpose if both of which of the following elements exist?

Insurable interest and consent

The medical information bureau (MIB) was created to protect

Insurance companies from adverse selection by high risk persons.

Which of the following entities can legally bind coverage?

Insurer

Who makes up the Medical Information Bureau?

Insurers

Which of the following best describes the MIB?

It's a nonprofit organization that maintains underwriting information on applicants for life and health insurance.

An insured stated on her application for life insurance that she had never had a heart attack, when in fact she had a series of minor heart attacks last year for which she sought medical attention. Which of the following will explain the reason a death benefit claim is denied?

Material misrepresentation

Which of the following would provide an underwriter with information concerning and applicants health history?

Medical information Bureau

What is a definition of a unilateral contract?

One-sided: only one party makes an enforceable promise

The federal fair credit reporting act

Regulates consumer reports

What is the best way to change an application?

Start over with a fresh application

Which f the following is NOT covered under Basic Hospital Expense Coverage?

Surgeons fees

Which of the following would basic medical expense coverage NOT cover?

Surgeons services

Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial information?

The Fair Credit Reporting Act

An insurer is attempting to determine the insurability of an applicant and decides to obtain medical information from several different sources. Which entity must be notified of the investigation?

The applicant

Which of the following would qualify as a competent party in an insurance contract?

The applicant has a prior felony conviction

Which is true regarding obtaining underwriting sources?

The applicant must be informed of the sources contacted and how the information is being gathered

Insurable interest can be best described by which of the following?

The applicant must experience a financial loss due to an accident of sickness that befalls the insured

Which of the following is true about the requirements regarding HIV exams?

The applicant must give prior informed written consent.

Which of the following is NOT the consideration in a policy?

The application given to a prospective insured

In insurance an offer is usually made when

The completed application is submitted

In comparison to consumer reports, which of the following describes a unique characteristic of investigative consumer reports?

The customer's associates, friends, and neighbors provide the report's data.

Which of the following best describes the first dollar coverage principle in basic medical insurance?

The insured is not required to pay a deductible

Which of the following is true regarding health insurance underwriting for a person with HIV?

The person may not be declined for medical coverage solely based on HIV status.

In terms of parties to a contract which of the following does NOT describe a competent party?

The person must have at least completed secondary education.

An insured is upset that her new health insurance policy was delivered to her by certified mail and not through her agent. Which of the following is true?

There is nothing wrong with this form of policy delivery

In insurance policies the insured is not legally bound to any particular action in the insurance contract but the insurer is legally obligated to pay losses covered by the policy. What contact element does this describe?

Unilateral

In insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insured is legally obligated to pay losses covered by the policy. What contract element does this describe?

Unilateral

In forming an insurance contract, when does acceptance usually occur?

When an insurer's underwriter approves coverage

Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following elements EXCEPT

conditions

When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following?

consideration

Which of the following is NOT an essential element of an insurance contract?

counteroffer

If an insured is not required to pay a deductible what kind of coverage does he/she have?

first dollar

On a health insurance application a signature is required from all of the following individuals EXCEPT

the spouse of the policyowner

If only one party to an insurance contract has made a legally enforceable promise, what kind of contract is it?

unilateral

Which of the following is a statement that is guaranteed to be true and if untrue may breach an insurance contract?

warranty