Accident and Health Insurance- Basics

The agent is known as the "Field Underwriter" because of the information he/she gathers for the insurer. This helps the insurer do what?

Avoid adverse selection

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30 day what?

Elimination period

Why is it essential for an insurer to document all correspondence with an insured?

Errors and omissions

Insured Zs health insurance policy year begins in January. His policy contains a carry over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?

The insured may carry over the amount of this years expenses to next year which will help satisfy next years deductible

What statement is false regarding an insured who is considered to be a standard risk?

The insured may have to pay slightly higher premiums

What is true about coinsurance?

The larger percentage the insured pays, the lower the premium

Which is generally true regarding insureds who have earned Preferred status?

Their premiums are lower

Which best describes the waiting period?

A period of time the insured has to wait before payments of benefits begin after disability

In which of the following situations is it illegal for an insurer to disclose privileged information about an insured?

A researcher for marketing purposes

What is the probationary period?

A specified period of time that a person joining a group has to wait before becoming eligible for coverage

The insureds health policy only pays for medical costs related to accidents. Which of the following types of policies does the insured have?

Accident only

What document describes an insureds medical history, including diagnoses and treatments?

Attending Physicians Statement

The factor added to the net premium to cover the costs of the insurer in obtaining and maintaining he business is called what?

Expenses

A producer is acting in what capacity when he or she is trying to obtain creditable information about an applicant for health insurance?

Field underwriter

Which of the following is another name for a primary care physician in an HMO?

Gatekeeper

(Mortality - Interest) + Expense = Net Premium. (loading)

Gross premium

What is one way in which HMOs are different from traditional health insurance policies?

HMO encourage preventative health care

In which of the following cases would a credit disability policy be issued?

If an individual is in debt to a specific creditor, payments will be made for him/her until they return to work

Upon the submission of a death claim under a life insurance policy, when should the insurer pay the policy benefit?

Immediately after receiving written proof of loss

Which document is used to assess the risk associated with an applicants lifestyle and character?

Investigative Consumer Report

What is franchise insurance?

It is health coverage for small groups whose numbers are too small to qualify for true group insurance

In franchise insurance, premiums are usually what?

Lower than individual policies, but higher than group policies

What piece of information regarding an insured is NOT included in an Investigative Consumer Report, which is requested by an underwriter?

Medical History

When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost, it is called what?

Preferred Provider Organization (PPO)

An insurer wishes to compare the information given in an insurance application with previous insurance applications by the same applicant but for different companies. What organization can help the insurer accomplish this?

The Medical Information Bureau (MIB)

Who will benefit from Extension of Benefits?

The client who was disabled prior to a policy discontinuance and remains disabled

Blue Cross Blue Shield organizations

They are voluntary not for profit organizations; they are not insurance companies

When is the insurability conditional receipt given?

When the premium is paid at the time of application