X-cel Accident and Health insurance Policy Chapter 10 - Health Underwriting

When an applicant reads and signs an insurance application, he/she should be conscious of the fact that:

A false statement can lead to loss of coverage

Which of the following best describes a point of service plan (POS)?

A plan which combines indemnity plan features with those of an HMO

What does the term "Field Underwriting" refer to in the health insurance Industry?

A producer's contact with the applicant

An attending Physician's statement is best described as

A summary of Medical History from the physician listed on the application

In what situation could an insurance policies coverage be modified?

Applicant is a substandard risk (Not if standard, preferred, or uninsurable)

Which of the following situations would a medical exam NOT be required for an individual health insurance applicant?

Applicant's family members have a history of cancer

What is a Pap test designed to detect?

Cervical Cancer in women

Which report contains information regarding an individual's general reputation and credit standing?

Consumer Report (info about Credit, Reputation, and habits).

Reductions in coverage are one feature of __________ in Health insurance policies.

Cost containment

Which of these is NOT a responsibility of an insurance producer?

Determining the final rate classification (Asking relevant questions concerning an applicant's avocations, requesting an attending physicians report (APR), and ordering an inspection report are all responsibilities of an insurance provider.)

To which of the following group health plans do HIPPA rules not apply?

Disability Income (HIPPA rules apply for HMO's, PPO's, and Major Medical)

Which of the following are used by most insurers when determining the premiums for large groups?

Experience Rating

Which of these is not a factor in a health insurance underwriting process?

Former Residence (Current residence, occupation, and physical condition are all relevant factors)

When the disclosure of an insured's nonpublic information is involved, what is the insurer obliged to do?

Give notice, explain, and allow opting out

An insured may be required to sign which document at policy delivery to ensure that there has not been any adverse medical conditions at the time of the application?

Good health statement

Kyle is an insured who disregarded an accident and health insurance policy provision that requires him to seek a second surgical opinion. What will the end result be?

He may be reimbursed for the surgical procedure at a reduced benefit level

Lamont has a point of service plan and is seeking to obtain health services outside the network. What will likely be the end result?

Higher out-of-pocket expenses

The Medical Information bureau consists of members from which group?

Insurance Companies

Which of the following statements regarding hospital pre admission authorization is not true?

It encourages Weekend Admission. (No delays for emergency treatment, non emergencies require notification to Insurance company, and other types of treatment may be encouraged are all true).

All of these are duties that a producer may be required to perform when delivering an insurance policy except:

Leave a Conditional receipt with client. (Acquiring a statement of health signature, gathering initial premiums, and reviewing the policy with the applicant are all duties).

Julie is an employee with a group health plan that contains that mandatory second surgical opinion provision. What is to be expected with this provision in place?

Out of pocket expenses are lower when a second surgical opinion is obtained as opposed to only having one.

A health insurance applicant is notified that a physical examination is required. Which of the following statements is correct?

Physical examinations are performed at the expense of the insurer

Where is the difference between a standard risk and a substandard risk reflected?

Premium Charges (higher if substandard

Which of the following is NOT a basic underwriting action for accident and health insurance?

Removing Uniform Policy Provisions (declining applications, excluding a particular health condition from coverage, and issuing a policy at a standard issue are all basic actions for underwriting).

Which of these is NOT considered the responsibility of a producer in the underwriting process?

Setting the final approval date

K is an agent who takes an application for individual accident and health insurance and accepts a check from a client. He submits the application and check to the insurance company, however the check was never signed by the applicant. If the application was approved, when will coverage be effective?

The date the producer delivered the policy, collected the initial premium, and obtained a good health statement from the insured.

How does an underwriter take into account an applicant's marital status?

When determining who is eligible for dependent coverage

When does the producer give a premium receipt for an accident and health insurance application?

When the initial premium has been collected with the application

A Health insurance Underwriter will most likely view alcohol abuse as an

increased exposure to risk

After a Health Insurance application has been originated, the producer normally

is the major personal contact to the insured

A signed good health statement may be collected by a producer at the time of

policy delivery

When a health insurance policy includes a mandatory second surgical opinion provision, the insured must

seek a second opinion for specified elective surgeries