Ch 8

Pre-existing Condition

A medical condition that was treated prior to the effective date of a policy is a:

Is performed by a licensed professional and includes checking vital statistics and routine lab work A medical exam is paid for by the insurer and does not require written consent under the FCRA. A written statement from the applicant's doctor explaining treatment for a preexisting condition is an attending Physician's statement. The medical exam is completed by usually a registered nurse or a paramedical professional and includes checking vitals, height, weight, and collecting blood and urine samples.

A medical or physical exam requested by the underwriter to determine insurability:

Medical exam This scenario is an example of using a medical or physical exam to assist in underwriting. An Attending Physician's Statement is a form completed by a physician regarding a current medical condition, and the MIB is a third party that reports information about past insurance the applicant has applied for or owned.

After K completed an application for health insurance, a paramedical scheduled an appointment to check height, weight, blood pressure, and collect blood and urine samples. This is an example of which source of underwriting?

College roommates

All of the following are examples of insurable interest between the insured and policyowner, except:

College Degree

All of the following are sources that insurers may look at for information regarding the insurability of a prospective insured, except:

The financial ratings from each rating service Upon issue of a new policy, there may be a new waiting period (probationary period) for pre-existing conditions or the policy may be issued with lower benefits, or with more limitations or exclusions compared to the old policy. Premiums may also be higher in the new policy.

Consumers must be made aware of all of the following in a replacement sale, except:

The insurer's counteroffer Whenever a policy is issued other than applied for the insurer is making a counteroffer which must be accepted prior to coverage coming into force. The issued policy does not represent constructive delivery, acceptance, or a legal contract until the insured pays any additional premium and accepts the counteroffer.

G applies for a policy as a standard risk after paying the initial premium. After thorough underwriting, the insurer issues the policy as a substandard risk. The issued policy represents:

Privacy of health information

HIPAA ensures which of the following?

Mary Beneficiaries are not required to sign. The agent must sign on behalf of the company, and the insured, not being a minor, must give consent to being insured. The policy owner, who is also the applicant, must by definition sign the application.

Howard talks to his agent Jane about buying a critical illness policy from the XYZ insurance company to cover his wife Deborah, and naming his daughter Mary as the beneficiary in case of death. Jane told him that she would need signatures from all of the following, except:

The Producer can make the change and have the insured initial the change

If a change or correction must be made on the application for insurance, which of the following applies?

Acceptance

If a premium was not submitted with the application, the producer must deliver the policy, explain the benefits, and collect the premium. The issued policy is the Offer and the premium becomes the:

Coverage would be as stipulated in the policy because the company issued the policy even though the question was left blank If a policy is issued with questions unanswered, the contract will be interpreted as if the question had not been asked and is therefore waived by the insurer. However, if the insurer can demonstrate that an inadvertent omission is a material concealment, the policy may be voided, because intentional or unintentional concealment allows the insurer to void the policy.

If the insurer issues a policy after receiving an application for health insurance in which questions regarding preexisting conditions were left blank, what would be the consequence to the insured's coverage if a preexisting condition caused a claim shortly after the policy was issued?

It will be assumed that the insurer waived their right to have answers to those questions If a policy is issued with application questions unanswered, the contract will be interpreted as if the question had not been asked and is therefore waived by the insurer.

In the event there is a policy issued and there are questions on the insurance application that went unanswered:

Inspection Report

Information about an applicant's work behavior or character gathered from neighbors or co-workers would be included on an?

Agent The applicant and the agent are required to sign and application for insurance. If the insured is not the applicant and is not a minor, a signature is also required.

Other than the applicant, which signature is required on an application?

Representations

Statements made on the application are considered true to the best of the applicant's knowledge and belief are considered to be:

Representations Representations are statements made and believed to be true to the best of a person's knowledge. Warranties are statements of absolute truth.

Statements made on the application are considered true to the best of the applicant's knowledge and belief are considered to be:

Credit score

The Medical Information Bureau provides information to the insurer regarding the individual risk of an applicant and does not include:

The most hazardous of the two When one has two occupations, the most hazardous is used for rating, regardless of hours worked or experience in each.

An applicant for accident and health insurance works two jobs. Which of the applicant's jobs will be used to underwrite the policy?

It is not included as part of the contract If attached to the policy, a copy of the application becomes part of the entire contract.

All of the following statements regarding an insurance application are correct, except:

Consumer Investigative Report A Consumer Investigative Report is a general report of the applicant's finances, character, morals, work, hobbies and other habits. It is sometimes called an Inspection Report.

The insurer's underwriter may find information about an applicant's moral character, hobbies, work and general reputation from a:

Insurers can refuse to issue a policy based on HIV test results Insurers can require an HIV test before issuing coverage, and can refuse coverage based on test results.

When it comes to health insurance underwriting and HIV/AIDS, which statement is TRUE?

Inspection report

Which of the following documents used for underwriting can be completed by talking to the proposed insured over the phone?

Producer and the applicant The producer and the applicant must sign the application. If the applicant and insured are different, then both must sign as well as the producer.

Which of the following is required to sign the application for insurance?