Chapter 5: Field Underwriting Procedures Flashcards
A(n) “______” must be issued to all applicants for health insurance coverage. This notice informs the applicant that a credit report will be ordered concerning his or her past history and any other health insurance for which they have previously applied.
Notice to the Applicant
The agent must take special care with the ______ of the application in the interest of both the company and the insured.
Accuracy
Every health insurance application requires the ______ of the proposed insured, the policyowner (if different than the insured), and the agent who solicits the insurance.
Signature
If changes are made to an incorrect answer on an application, draw a line through the incorrect response and write a new one. The ______ must initial the correct answer.
Applicant
In cases where a premium did not accompany the application for insurance, upon delivery, the agent must collect the premium and obtain a(n) ______ from the applicant before releasing the policy.
Statement of Continued Good Health
The ______ is the best source for accurate information on the applicant’s medical history.
Attending Physician’s Statement (APS)
Underwriting for ______ or ______ is permitted as long as it is not unfairly discriminatory. An adverse underwriting decision is not permitted if based solely upon the presence of symptoms, but only if ______ is confirmed in relation to the symptoms.
- HIV or AIDS
2. HIV
Under the ______ for HIPAA (Health Insurance Portability and Accountability Act), protected information includes all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. This is called ______.
- Privacy Rule
2. Protected Health Information (PHI)
The agent has a responsibility to provide the insured with an explanation of the policy’s main ______ and ______.
- Benefits
2. Provisions
When an agent attempts to replace the insured’s current health insurance policy with a new one, the agent needs to be careful not to ______ the insured or provide coverage that is to the insured’s ______. It is the agent’s responsibility to carefully compare the ______, ______, and ______ found in the current and the proposed replacement policy.
- Mislead
- Detriment
- Benefits
- Limitations
- Exclusions
When replacing a health insurance policy, the agent must make sure that the current policy is not ______ before the new policy is issued.
Cancelled
______ are medical conditions for which the insured sought medical advice or treatment within a specified period of time prior to the policy issue. They are a very important consideration when replacing a policy.
Pre-Existing Conditions
The insured may be under the assumption that a replacing policy is in his/her best interests, but after being evaluated by a(n) ______, where premium and risk are exchanged, an insured may not be paying the same premium or receiving the same benefits.
Underwriter
Elements of a Legal Contract:
______: offer and acceptance
______: premiums and representations on the part of the insured; payment of claims on the part of the insurer
______: of legal age, sound mental capacity, and not under the influence of drugs or alcohol
______: not against public policy
- Agreement
- Consideration
- Competent Parties
- Legal Purpose
Contract Characteristics:
______: one party prepares the contract; the other party must accept it as is
______: exchange of unequal amounts
______: certain conditions must be met
______: only one of the parties to the contract is legally bound to do anything
- Adhesion
- Aleatory
- Conditional
- Unilateral
Sources of Insurability Information:
______: best for accurate information on the applicant’s medical history
______: helps companies share adverse medical information on insureds
______: contain factors related to a risk’s potential for loss; includes consumer reports and investigative consumer reports
______: conducted by physicians or paramedics
- Attending Physician Report (APR)
- Medical Insurance Bureau (MIB) Report
- Credit Reports
- Medical Exam Report
The earliest that coverage could start would be the day of ______, assuming the applicant paid the first premium, had no conditions to fulfill, and had not lied.
Application
A(n) ______ application is usually returned. Should the underwriter approve it as is, coverage begins. If this occurs, the company gives up some of its ability to contest a claim.
Incomplete
The ______ collects claim information.
Medical Information Bureau (MIB)
Coverage can never begin unless the ______ has been paid. Even though the ______ has been paid, coverage will NOT start until the applicant has satisfied all of the conditions of the ______, if any.
- Premium
- Premium
- Conditional Receipt
The ______ determines the final rating classification, not the ______.
- Underwriter
2. Producer
A(n) ______ and ______ must be left with the applicant prior to accepting the initial premium.
- Buyer’s Guide
2. Policy Summary
Although the ______ must sign the application, he or she is not a party to the contract.
Producer
It is the responsibility of the ______ to explain the policy provisions, riders, and exclusions to the policyowner and/or insured.
Producer
The applicant’s ______ is both the answers on the application and the premium. In return, the insurance company promises coverage. ______ does not have to be equal.
Consideration
______ must exist at the time of application, but not necessarily at the time of a claim.
Insurable Interest
______ may be based on economics or family relationships.
Insurable Interest
An absolute guarantee of truth is called a(n) ______.
Warranty
