Health - Underwriting

The disability income policy most likely to have been issued on a substandard basis is

A) non-cancelable with a 60-day elimination period
B) conditionally renewable
C) non-cancelable with a health condition exclusion rider
D) guaranteed renewable with an inflation rider

Which of the following are used by most insurers when determining the premiums for large groups?

A) experience rating
B) group rating
C) area rating
D) large number rating

Which of these plans allow a participant to choose either a network or non-network provider at the time when medical care is needed?

A) point-of-service
B) limited benefit
C) Medicare Supplement
D) HMO

Which of the following situations would a medical exam NOT be required for an individual health insurance applicant?

A) applicant was recently hospitalized
B) applicant has no prior health insurance
C) applicant's family members have a history of cancer
D) applicant has not a physical exam in a number of years

Which of the following best describes the tax treatment of medical expense policies for the self-employed?

A) 50% of medical expense plan premiums are tax deductible
B) 7.5% of medical expense plan premiums are tax deductible
C) 100% of medical expense plan premiums are tax deductible
D) 0% of medical expense plan premiums are tax deductible

Which statement is true regarding hospital permission certification for emergency situations?

A) notification is not required for emergency situations
B) notification is required to be given after insured to the hospital
C) notification is required to be given before insured is admitted to the hospital
D) insured cannot be admitted without preadmission certification

Which of these is NOT a factor during the health insurance underwriting process?

A) occupation
B) physical condition
C) former residence
D) current residence

Julie is an employee with a group health plan that contain the Mandatory Second Surgical Opinion provision. What is to be expected with this provision in place?

A) Out-of-pocket expenses are higher when a second surgical opinion is obtained as opposed to having only one
B) Mandatory second surgical opinions are required when emergency surgery is needed
C) The second surgical opinion must always be accepted by the insured
D) Out-of-pocket expenses are lower when a second surgical opinion is obtained as opposed to having only one

How is a community rating used for underwriting purposes?

A) the same rates are charged for individual and group plans in the same risk category
B) each individual and group plan in the same geographical area is individually underwritten
C) each member of a large group is individually underwritten
D) the same rates are charged for individual and group plans in the same geographical area

A health insurance applicants is notified that a physical examination is required. Which of the following statements is correct?

A) all applicants for health insurance do not require a physical examination
B) physical examinations are performed at the expense of the applicant
C) physical examinations are performed at the expense of the insurer
D) all applicants for group health insurance require a physical examination

A health insurance underwriter will most likely view alcohol abuse as a(n)

A) decreased exposure to risk
B) increased exposure to risk
C) condition which results in an automatic rejection for coverage
D) condition which cannot be taken into account

Mary is the sole proprietor of her business and has a family health plan. She would like to deduct the premiums from her taxes. What percentage of her premiums are tax deductible?

A) 0%
B) 50%
C) 75%
D) 100%

Which of these is NOT an underwriting responsibility of an insurance producer?

A) requesting an attending physician's report (APR)
B) determining the final rate classification
C) ordering an inspection report
D) asking relevant questions concerning an applicant's avocations

In what situation could an insurance policy's coverage be modified?

A) applicant is a preferred risk
B) applicant is uninsurable
C) applicant is a standard risk
D) applicant is a substandard risk

Tim is in need of surgery. Before being hospitalized, he is referred to an outpatient clinic for diagnostic tests. What is this an example of?

A) mandatory second opinion
B) pre-admission testing
C) concurrent review
D) capitation

Lamont has a point-of-service plan is seeking to obtain health services outside the network. What will like be the end result?

A) increase in premiums
B) reduction in care given
C) denial of specialized services
D) higher out-of-pocket costs

What does the term "field underwriting" refer to in the health insurance industry?

A) the medical reports issued by the MIB
B) the interaction of an underwriter with the applicant
C) a producer's contact with the applicant
D) an insurer conducting an investigative report

Which of these noncontributory group plans would a claim likely result in the payment of federal income taxes?

A) blanket health
B) disability income
C) major medical
D) accidental death

Once a child is born and covered under and accident and health plan, any reduction in benefits on the newborn is

A) strictly prohibited
B) prohibited only under high-deductible plans
C) allowed under specific conditions
D) allowed in any situation

If a life insurance agent is shown future premiums are to be paid out of non-guaranteed values, the illustration used in the sales representation MUST

A) disclose that premium payments may need to be resumed depending on the actual results
B) be given to the insured within 10 days after policy delivery
C) be notarized and signed by the Commission
D) disclose that premium payments are guaranteed to be permanently forfeited by the insurer

Every ___ year(s), an agent's license in Virginia must be renewed

A) two
B) one
C) three
D) four

An agent who is attempting to intimidate is engaging in

A) discrimination
B) defamation
C) coercion
D) twisting

A cease and desist order issued against the agent

A) can only be issued by the Attorney General
B) permits the suspension or revocation of the license immediately
C) voids all agent appointments
D) prohibits a specific practice listed in the order

Once an insured is notifies an insurer of a claim, what must the insurer do?

A) conduct a physical examination
B) pay the claim
C) send out a claim form
D) investigate the claim

Carlos the agent has sold an insurance policy and will be sharing the commission with another individual. Which of the following individuals may Carlos share the commission with?

A) the underwriter
B) another licensed but unappointed agent
C) the client
D) an unlicensed individual

Under Federal Law, which of the following actions may result in a producer becoming imprisoned?

A) producer selling insurance with a nonresident license
B) producer embezzling funds from the insurer
C) producer replacing an existing insurance policy with a new one
D) producer writing controlled business

What is the role of the replacing insurer during a life insurance replacement transaction?

A) match or beat the current premium of the existing policy
B) nothing, the agent handles all aspects of the transaction
C) send notice of the proposed replacement transaction to the existing insurer
D) waive all underwriting of the replacing policy requirements

Under the Affordable Care Act, each of the following is considered an Essential Health Benefit EXCEPT

A) dialysis
B) mental health services
C) childbirth
D) preventive and wellness services

Which of these is NOT considered advertising?

A) an agent's oral sales presentation
B) an AM Best company rating
C) a policy illustration
D) a direct mailing from the insurer

Employees are required to work __ hours per week to become eligible for small employer health plan

A) 20
B) 30
C) 40
D) 25

Administrative actions taken against an agent must be reported to the State Corporation Commission within __ days of the final disposition

A) 20
B) 30
C) 15
D) 25