Health Insurance Underwriting Vocab & Notes Chap 7B Flashcards
A form supplied by the insurance company, usually filled in by the agent and medical examiner (if applicable) on the basis of information received from the applicant. It is signed by the applicant and is part of the insurance policy if it is issued. It gives information to the home office underwriting department, so it may consider whether an insurance policy will be issued and, if so, in what classification and at what premium rate.
The Application
This part of the application asks general questions about the proposed insured, including name, age, address, birth date, sex, income, marital status, and occupation.
Details about the requested insurance coverage are also included in this Part such as:
- Type of policy
- Amount of insurance
- Name and relationship of the beneficiary
- Other insurance the proposed insured owns
- Additional insurance applications the insured has pending
- Other information sought may indicate possible exposure to a hazardous hobby, foreign travel, aviation activity, or military service.
- Tobacco use.
General (Part 1)
This part of the application focuses on the proposed insured’s health and asks a number of questions about the health history, not only of the proposed insured, but of the proposed insured’s family, too. This section must be completed in its entirety for every application. Depending on the proposed policy face amount, this section may or may not be all that is required in the way of health information. The individual to be insured may be required to take a health exam and/or provide a blood test or urine specimen. Physical exams, if requested by the insurer, are performed at the expense of the insurer.
Medical (Part II)
This part of the application is where the agent details personal observations about the proposed insured. Because the agent represents the interests of the insurance company, the agent is expected to complete this part of the application fully and truthfully. In this Part , the agent provides additional information about the applicant’s financial condition and character, the background and purpose of the sale, and how long the agent has known the applicant. It also usually asks if the proposed insurance will replace an existing policy. If the answer is yes most states demand that certain procedures be followed to protect the rights of consumers when policy replacement is involved.
Agent’s Report (Part III)
A report ordered by the insurance company and completed by a physician, hospital or medical facility who has treated, or who is currently treating, a person seeking insurance. It is one of the most frequently ordered additional sources of medical background information and can be for a specific ailment (diabetes, broken leg, etc.) or for a general family doctor.
An attending physician statement (APS)
These receipts are given by a company upon an applicant’s first premium payment. The policy, if approved, becomes effective from the date of the receipt.
Binding Receipts
An informational consumer reference that explain insurance policies and insurance concepts; in many states, they are required to be given to applicants when certain types of coverages are being considered. And are often used with life insurance, long-term care insurance, and annuities.
A Buyer’s Guide
This Receipt is given to the policy owners when they pay a premium at time of application. Such receipts bind the insurance company if the risk is approved as applied for, subject to any other specifications stated on the receipt.
A Conditional Receipt
A summary of an insurance applicant’s credit history, made by an independent organization that has investigated the applicant’s credit standing.
Credit Report
_______________ is accomplished technically if the insurance company intentionally relinquishes all control over the policy and turns it over to someone acting for the policyowner, including the company’s own agent. It can also involve mailing the policy to an agent for unconditional delivery to the policyowner, even if the agent doesn’t personally deliver it.
Constructive delivery
A federal law requiring an individual to be informed if she is being investigated by an inspection company. The law also outlines the sharing and impact of such information and requires individuals to be notified prior to being investigated.
The Fair Credit Reporting Act
Reports of an investigator providing facts required for a proper underwriting decision on applications for new insurance and reinstatements.
Inspection Reports
A service organization that collects medical data on life and health insurance applicants for member insurance companies.
The Medical Information Bureau
A summary of the terms of an insurance policy, including the conditions, coverage limitations, and premiums. And are often used with life insurance, long-term care insurance, and annuities. Preferred is a risk whose physical condition, occupation, mode of living, and other characteristics indicate a prospect for longevity for unimpaired lives of the same age.
A Policy Summary
Statements an applicant makes as being substantially true to the best of the applicant’s knowledge and belief, but which are not warranted to be exact in every detail. These statments must be true only to the extent that they are material to the risk.
Representations
