Chapter 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 or physical exam requested by the underwriter to determine insurability:

At the date of application

A premium is paid at the time of application and a conditional receipt is issued. If the policy is issued as applied for, and assuming a medical exam has already been completed, coverage becomes effective:

Field underwriting

A producer gathers information about the applicant for the insurer in order to avoid adverse selection. This is considered to be:

Accidental injury and sickness

Accident and Health Insurance provides coverage for two major categories of perils. They are:

Fair Credit Reporting Act

An insurance applicant must be notified prior to an insurer ordering an investigative or financial report as required by which law?

Insurer's home office underwriter

Ultimately, insurability of an applicant is determined by the

The insurer has the right to share identifiable health information with the agent

Regarding HIPAA disclosures and privacy rules, before an insurer can share any medical information, the applicant must be notified of all the following, except:

Representations

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

Field underwriting

__________ is the initial step of the total process of insuring a health risk.

Sudden, unexpected and unforeseen event

Accidental Injury is a:

Medical exam

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:

It is not included as part of the contract

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

Attending physician's statement

An application for health insurance includes all of the following information, except:

Insured

Before a policy will be issued, an insurable interest must exist between the owner (applicant) and the

The financial ratings from each rating service

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

Denies the claim because the insurer would not have issued the policy as applied for as standard or better

Edward applies for a disability insurance policy. He pays the initial premium at the time of application and receives a conditional receipt. Three days after the insurance company conducts a medical examination, but before it issues a policy, Edward suffers a stroke. Upon reviewing the results of his medical exam, the company discovers that Edward has been diagnosed with high blood pressure and atherosclerosis. Under the terms of the conditional receipt, the insurance company:

Due to the risk of a moral hazard

Field underwriting is very important:

The insurer's 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:

Mary

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?

Policy was issued with a higher premium due to the increased risk

If a policy is issued with a surcharge, this means that the

Pay the first premium

If a premium was not paid at the time of application and a policy is issued, all the following are responsibilities of the agent/producer, except:

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:

The insurer would require an answer before issuing a policy

If an application is submitted with a question left unanswered, which of the following should occur?

Covered since the insurer issued the contract based on an incomplete application

If questions are incomplete on an application and the insurer issues the policy, a claim is:

Statement of Good Health

If the insurer issues a health insurance policy without an initial premium, the producer must obtain a signed:

Conditional receipt

If the premium is paid at the time of application, the agent will provide the applicant with a:

It will be assumed that the insurer waived their right to have answers to those questions

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

A statement of good health

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

Inspection Report

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

agent

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

When the policy is delivered to P and the premium is paid

P has had some health issues over the years and is not confident he will qualify for standard issue insurance. If P completes an application and submits it to the insurance company without paying the premium up-front, coverage will take effect

Cancelling an existing policy and issuing a new policy

Policy replacement is the process of:

Make arrangements to meet X in-person to obtain the missing information and correct the incorrect response

Producer W filled out an application on client X. Before submitting the application to the insurer, W notices that there was one question left unanswered and another one was answered incorrectly based on the information provided. Since X lives over an hour away from the office, W should do which of the following?

Credit score

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

To make sure the application provides the proper information

The agent's primary underwriting role is:

Probationary period

The specified period that must elapse before new coverage is effective for nonaccidental losses is known as which of the following?

The specified period that must elapse before new coverage is effective for nonaccidental losses is known as which of the following?

The specified period that must elapse before new coverage is effective for nonaccidental losses is known as which of the following?

Political affiliation and religious preference

What factors are not used in underwriting an individual disability policy?

The application

What is the primary source of underwriting information for an individual health insurance policy?

An attending physician statement

When Harry completed his insurance application, the agent discovered that he was under treatment for a chronic condition. In order to gather the necessary information, Harry's agent ordered a/an:

Legally Delivered

When a policy is mailed to an agent by an insurer after being accepted as applied for and the initial premium paid, it is considered to be:

Insurers can refuse to issue a policy based on HIV test results

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

Present health and medical background of applicant and family

Which of the following are included in Part II of a Health Insurance Application?

Inspection report

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

Producer

Which of the following has primary responsibility for ensuring that the application is filled out completely?

Spouse's occupation

Which of the following is not considered an underwriting factor when determining insurability for health insurance?

Producer and the applicant

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

The agent's report

Which of the following items does not become part of the insurance contract as defined in the entire contract clause?

Notice of Information Practices

Which of the following must be given to consumers under the provisions of the Fair Credit Reporting Act (FCRA)?

Any change or correction must be initialed by the applicant

Which of the following statements is correct regarding changes in the application?

Diabetes

Which of the following would be considered a pre-existing condition?

Marital status

Which one of the following is not a factor when an insurer underwrites a policy?