Ch 2 Accident and Health Insurance Basics Flashcards
KT
The two major perils covered and health insurance policies are:
Accidental bodily injury and sickness
KT
Medical expense benefits are considered:
Reimbursement benefits
KT
Limited policies cover a specific _______ or _________ only.
Sickness or accident only.
KT
In AD&D policies, the principal sum means the full face amount (100%), and the capital sum is a percentage of the face amount.
True
KT
A producer is the companies __________.
field underwriter.
MIB
Medical information bureau
What two major types of losses does health insurance cover?
Accidental bodily injury and sickness
What are common exclusions from coverage and health insurance policies?
War injuries, intentionally self-inflicted injuries, elective cosmetic surgery
What process helps minimize the problem of adverse selection?
Underwriting
Who’s responsibility is it to inform an applicant for health insurance about the insurers information gathering practices?
The agent
Who is the field underwriter?
Agent/producer
What type of hospital policy pays a fixed amount each day that the insured is in the hospital?
Hospital indemnity
What is the entire contract and health insurance underwriting?
The application in the policy issued
What is the term used for a written request for an insured to issue an insurance contract based on the provided information?
Application
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
During which stage in the insurance process do insurers evaluate information that identifies adverse selection risk?
Underwriting
People who are more likely to submit insurance claims are seeking insurance more often than preferred risks.
adverse selection
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?
The applicant
In health insurance, what is considered a sickness?
an illness that first arises while the policy is in force
Who must sign a health insurance application?
The policy owner, the insured (if different), and the agent
What do limited health policies cover?
A specific accident or disease
Under a credit disability policy, payments to the creditor will be made for the insurer until what point in time?
Until the period of disability ends or until the debt is repaid
If an agent makes a correction on the application for health insurance who must initial the correct answer?
The applicant
Who is responsible for paying the cost of a medical examination required in the process of underwriting?
Insurer
Most health policies will pay the accidental death benefits if the death is caused by an accident and occurs within how many days?
90 days
In insurance, what is the term used for a cause of loss?
Peril
What is the capital sum in Accidental Death and Dismemberment (AD&D) coverage?
A percentage of the principal sum
During the application process for health insurance, a producer is trying to obtain credible information about the applicant that would help underwriters determine if the risk is insurable. In what role is the producer acting?
Field underwriter
Who’s responsibility is it to determine that all the questions on an insurance application are answered?
The agent’s
In medical expense contracts, what is the term that describes a payment method when the insured is responsible for paying the medical expenses, and then the insurer pays directly to the insured?
Reimbursement
What are the two types of expenses that are covered by health insurance?
Expenses related to healthcare, and expenses that compensate for loss of income
If an applicant does not receive his or her insurance policy, who would be held responsible
The agent
In health insurance, the policy itself and the insurance application form what?
The entire contract
Which is NOT true regarding an insured who is considered to be a standard risk?
A the insured may have to pay slightly higher premiums
B the insurance lifestyle is incorporated into this risk judgment
C the insured’s level of health is representative of others in the same age cohort
D special restrictions on the policy are not necessary
The insured may have to pay slightly higher premiums
The “Standard” rating indicates that an individual represents similar level of health and lifestyle quality as other members of the same age cohort. These individuals do not need special policy restrictions or are not required to pay higher premiums.
