chapter 7b- health insurance underwriting

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

which of these is NOT a factor during the health insurance underwriting process?

former residence

Julie is an employee with a group health plan that contains the 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 having only one

Mary is the sole proprietor of her business and has a family health plan. She would like to deduct the premiums from her taxes. What percentage of her premiums are tax deductible?

100%

which of the following best describes the tax treatment of medical expense policies for the self-employed?

100% of medical expense plan premiums are tax deductible

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

a plan which combines indemnity plans features with those of an HMO

what is normally the consequence for NOT obtaining readmission certification prior to receiving inpatient medical care?

a reduction in benefits

what is normally the consequences for NOT obtaining readmission certification prior to receiving inpatient medical care?

a reduction in benefits

which of the following distinguishes field underwriting from home office underwriting?

an agent has personal contract with an applicant

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

cost containment

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

the type of health insurance in which underwriting procedures are the most restrictive is

individual

who must sign a rider attached to a health insurance policy in order for it to be valid?

insured and producer

an applicant for accident and health insurance has a risk factor that is similar to a majority of the insurer's other applicants.

issued with a standard premium rate

which of the following statements regarding hospital pre-admission authorization is NOT true?

it encourages weekend admission

the disability income policy most likely to have been issued on a substandard basis is

non-cancelable with a health condition exclusion rider

which statement is true regarding hospital readmission certification for emergency situations?

notification is required to be given after insured is admitted to the hospital

a disability income insurance policy was recently issued with a rating. What does this mean?

policy owner will be charged an additional premium

Tim is in need of surgery. Before being hospitalized, he is referred to an outpatient clinic for diagnostic tests. What is this an example of?

pre-admission testing

which of these is a typical result of a concurrent review?

the length of time spent in the hospital is monitored

how is a community rating used for underwriting purposes?

the same rates are charged for individual and group plans in the same geographical area