MO Health - 30 Health Ins Basics/Field Underwriting Procedures
Q: What is the capital sum in Accidental Death and Dismemberment (AD and D) coverage?
A: A percentage of the principal sum
Q: What do limited health policies cover?
A: A specified accident or disease
Q: What information are the members of the Medical Information Bureau required to report?
A: Adverse medical information about the applicants or insured
Q: At what age do individuals qualify for Medicare?
A: Age 65
Q: Who is a field underwriter?
A: Agent/Producer
Q: What are the four elements of an insurance contract?
A: Agreement (offer and acceptance), consideration, competent parties, and legal purpose
Q: What is a warranty in an insurance contract?
A: An absolutely true statement upon which the validity of the insurance contract is based
Q: In health insurance, what is considered a sickness?
A: An illness that first arises while the policy is in force
Q: What is the term used for a written request for an insurer to issue an insurance contract based on the provided information?
A: Application
Q: If an underwriter requires extensive information about the applicant's medical history, what report will best serve this purpose?
A: Attending Physician's Statement
Q: What type of group health insurance is used to provide accident coverage on a group of persons that are participating in a particular activity, when the individual insureds are unknown, and are covered automatically?
A: Blanket
Q: What type of health insurance would be most appropriate for a group of children in a summer camp?
A: Blanket
Q: What type of health insurance plans cover all accidents and sicknesses that are not specifically excluded in the policy?
A: Comprehensive plans
Q: Health contracts are prepared by insurers and must be accepted by the insured on an 'as is' basis. This describes what aspect of a health insurance contract?
A: Contract of adhesion
Q: What are the two types of expenses that are covered by health insurance?
A: Expenses related to health care, and expenses the compensate for loss of income
Q: During the application process for health insurance, a producer is trying to obtain creditable information about the applicant that would help underwriters determine is the risk is insurable. In what role is the producer acting?
A: Field underwriter
Q: What type of hospital policy pays a fixed amount each day that the insured is in the hospital?
A: Indemnity
Q: Who is responsible for paying the cost of a medical examination required in the process of underwriting?
A: Insurer
Q: What entities make up the Medical Information Bureau?
A: Insurers
Q: What report is used to assess risk associated with a health insurance applicant's lifestyle and character?
A: Investigative Consumer Report
Q: What entity provides underwriters with information concerning an applicant's health history?
A: MIB - Medical Information Bureau
Q: When must the Outline of Coverage be provided to the insured?
A: No later than policy delivery
Q: Health insurance contracts are unilateral. What does that mean?
A: Only one party makes a legally enforceable promise
Q: What is adverse selection?
A: People who are more likely to submit insurance claims are seeking insurance more often than preferred risks.
Q: In insurance, what is the term used for cause of loss?
A: Peril
Q: How can health insurance policies be delivered to the insured?
A: Personally delivered by the agent or mailed
Q: What characteristics would qualify an applicant for health insurance as a substandard risk?
A: Poor health history or a dangerous occupation or avocation
Q: What is the term used for a condition for which the insured has received diagnosis, care or treatment during a specified period of time prior to the health policy issue?
A: Pre-existing condition
Q: What risk classification would typically qualify for lower premiums?
A: Preferred risk
Q: In medical expense contracts, what is the term that describes the payment method when the insured is responsible for paying the medical expenses, and then the insurer pays directly to the insured?
A: Reimbursement
Q: What are the three types of risk rating classifications in health insurance?
A: Standard, substandard and preferred
Q: What risk classification would require the highest premium for a health insurance policy?
A: Substandard
Q: If an applicant does not receive his or her insurance policy, who would be held responsible?
A: The agent
Q: Whose responsibility is it to inform an applicant for health insurance about the insurer's information gathering practices?
A: The agent
Q: Whose responsibility is it to determine that all the questions on an insurance application are answered?
A: The agent's
Q: If an agent makes a correction on the application for health insurance, who must initial the correct answer?
A: The applicant
Q: If an insurer decides to obtain medical information from different sources in order to determine the insurability of an applicant, who must be notified of the investigation?
A: The applicant
Q: What is the entire contract in health insurance underwriting?
A: The application and the policy issued
Q: In health insurance, the policy itself and the insurance application form what?
A: The entire contract
Q: Who must sign a health insurance application?
A: The policyowner, the insured (if different), and the agent
Q: How is the information obtained for an investigative consumer report?
A: Through interviews with the applicant's associates, friends and neighbors
Q: What is the purpose of the Outline of Coverage in health insurance?
A: To provide the insured full and fair disclosure about the policy issued
Q: During which stage in the insurance process do insurers evaluate information that identifies adverse selection risks?
A: Underwriting
Q: Under a credit disability policy, payments to the creditor will be made for the insurer until what point in time?
A: Until the period of disability ends or until the debt is repaid
Q: What are the common exclusions in most health insurance policies?
A: War, self-inflicted injuries, pre-existing conditions, elective cosmetic surgeries, injuries cause by participating in illegal activities, and workers compensation benefits.
Q: In insurance, when is the offer usually made on a contract?
A: When the insurance application is submitted
Q: In forming an insurance contract, when does an acceptance usually occur?
A: When the insurer approves a prepaid application
Q: When should an agent obtain a Statement of Good Health from the insured?
A: When the premium was paid upon policy delivery and not at the time of application
Q: Most health policies will pay the accidental death benefits if the death is caused by an accident and occurs within how many days?
A: 90 days
Q: In health insurance contracts, the insured is not legally bound to any particular action
however, the insurer is obligated to pay for losses covered by the policy. What contract element does this describe?;A: Unilateral