Chapter 5: Field Underwriting Procedures

Adhesion

"take it or leave it"

In a replacement situation, all of the following must be considered

1) Exclusions 2)Benefits 3)Limitations

Coinsurance

1. Paid after the deductible and after the insurer paid its share 2. Percentage (usually 80/20) 3. The larger the coinsurance %, the lower the premium

Deductable

1. Paid first 2. Set dollar amount 3. The larger the deductible, the lower the premium

Who must sign a health insurance application?

1. Policyowner 2. Insured 3. Agent

Common Exclusions

1. War or military service 2. Self-inflicted injuries 3. Elective cosmetic surgery 4. Conditions covered by workers compensation 5. Conditions covered by government plans (if covered by them) 6. Participation is criminal activities

COBRA ACT applies to employers with...

20 or more employees

What information are the members of the Medical Information Bureau required to report?

Adverse medical information about the applicants or insured

What is the term used for a written request for an insurer to issue an insurance contract based on the provided information?

Application

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

If an underwriter requires extensive information about the applicant's medical history, what report will best serve this purpose?

Attending Physician's Statement

Who is responsible for paying the cost of a medical exam required in the process of underwriting?

Insurer

What entities make up the Medical Information Bureau?

Insurers

Cost sharing

Involves deductible and coinsurance

What is the best way to make a change on an application for insurance?

Start over with a fresh application

Whose responsibility is it to inform an applicant for health insurance about the insurer's information gathering practices?

The agent

If an agent makes a correction on the application for health insurance, who must initial the correct answer?

The applicant

If an insurer decides to obtain medical info from different sources in order to determine the insurability of an applicant, who must be notified of the investigation?

The applicant

What is the entire contract in health insurance and underwriting?

The application and the policy issued

What is necessary in order to be eligible to receive benefits from a long-term care policy?

The insured must be unable to perform some activities of daily living

In health insurance, the policy itself and the insurance application form what?

The entire contract

Aleatory

Unequal exchange

When should an agent obtain a Statement of Good Health from the insured?

When the premium was paid upon policy delivery and not at the time of application

Conditional

certain conditions must be met

Exclusions

not covered

All insurance policies are considered to be...

personal (between insurer and insured)

Insurable Interest

the policyowner facing the possibility of losing something of value in the event of loss

All insurance policies are...

unilateral (one-sided promise)