Chapter 7: Health Insurance Underwriting
South Carolina Pre-licensing Education - Life and Health Insurance
- 1.The difference between pre-certification and concurrent review is that pre-certification
- A.
Costs more to the patient
- B.
Costs less to the patient
- C.
Is considered to a cost containment measure
- D.
Occurs before the treatment is provided
- 2.The gatekeeper's role when used by an HMO is
- A.
Establishing out-of-network providers
- B.
Obtaining referrals to specialists from primary care physicians
- C.
Taking applications for enrollment into an HMO
- D.
Processing the subscriber'spayments
- 3.XYZ Corp pays the tax deductible insurance premiums for a key employee disability policy. Which of the following would be the appropriate tax consequence?
- A.
Premiums are paid with tax credits
- B.
Benefits are partially taxable
- C.
Benefits are fully taxable
- D.
Premiums are paid with after-tax dollars
- 4.In which of the following processes will the insurer oversee the insured's hospital stay to confirm everything is going according to schedule and that the insured will be released as planned?
- A.
Pre-certification
- B.
Pretense review
- C.
Congruent review
- D.
Concurrent review
- 5.Premium mode is a term used to describe the
- A.
Premium past due
- B.
Method of payment
- C.
Frequency of the premium payment
- D.
Premium paid
- 6.Which of the following is requirement for ANY change in an insurance application?
- A.
Change must be initialed by the agent
- B.
Change must be initiated by the applicant
- C.
Change must be approved by the insurer
- D.
Change must be notorized
- 7.The IRS allows a taxpayer to deduct medical expenses that exceed 7.5% of their adjusted gross income. Which of the following is considered a tax deductible medical expense under this rule?
- A.
Long Term Care insurance premiums
- B.
Dread Disease insurance premiums
- C.
Travel accidental insurance premiums
- D.
Individual disability income Insurance premiums
- 8.XYZ Company has applied for group health insurance for its employees. What information would the insurer's underwriters likely use to determine the appropriate coverage and final premium rate given to the group?
- A.
Experience rating
- B.
Credit reports
- C.
Arrest reports
- D.
AM Best rating
- 9.An insured was injured as an innocent bystander when someone committed a felony. The insurer is
- A.
Likely to void the policy
- B.
Partially liable for the loss
- C.
Not liable for the loss
- D.
Liable for the loss
- 10.Which of the following typically does NOT provide a form of managed care?
- A.
Preferred Provider Organization (PPO)
- B.
Pont-of-Service (POS) plan
- C.
Major medical indemnity plan
- D.
Health Maintenance Organization (HMO)
- 11.Which of these characteristics of a applicant is NOT taken into consideration when assessing risk for Disability coverage?
- A.
Health of applicant
- B.
Gender of applicant
- C.
Number of children
- D.
Occupation of applicant
- 12.Tara the producer is delivering a specified disease insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT a(n)
- A.
Initial premium
- B.
Signed impairment rider acknowledgment
- C.
Modified application with a new signature
- D.
Good health statement
- 13.A 10% excise tax is normally applied to an early withdrawal from an IRA. According to HIPAA, this tax will not be applied if the withdrawal is used for medical expenses that exceed (blank) of the individual's adjusted gross income.
- A.
5%
- B.
6.5%
- C.
7.5%
- D.
8%
- 14.Which of the following is NOT an example of utilization review?
- A.
Monitoring length of hospital stay
- B.
Ongoing inspection of accident prone individuals
- C.
Monitoring the appropriateness of care
- D.
Setting a hospital release date for a patient
- 15.Bill the producer is collecting the initial premium on a health policy. Which of the following statements is true?
- A.
The contract is not in force without the initial premium being paid
- B.
A partial initial premium is acceptable
- C.
The insured has no advantage to pay the initial premium at the time of application
- D.
A claim must be honored by the insurer even if an initial premium is not paid
- 16.The IRS allows a taxpayer to deduct medical expenses that exceed 7.5% of their adjusted gross income. Which of the following is considered a tax deductible medical expense under this rule?
- A.
Long Term Care insurance premiums
- B.
Dread Disease insurance premiums
- C.
Travel accidental insurance premiums
- D.
Individual disability income Insurance premiums
- 17.In which of the following processes will the insurer oversee the insured's hospital stay to confirm everything is going according to schedule and that the insured will be released as planned?
- A.
Pre-certification review
- B.
Pretense review
- C.
Congruent review
- D.
Concurrent review
- 18.An example of primary care physician would be a(n)
- A.
Internist
- B.
Psychologist
- C.
Endocrinologist
- D.
Chiropractor
- 19.How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes?
- A.
Partially tax deductible
- B.
Not tax deductible
- C.
Fully tax deductible
- D.
Tax deferred
- 20.Premium mode is a term used to describe the
- A.
Premium past due
- B.
Method of payment
- C.
Frequency of the premium payment
- D.
Premium paid
- 21.What happens when an insurance policy is backdated?
- A.
The policy's elimination period is waved
- B.
The time frame for reinstating a lapsed polkicy is extended
- C.
The policy's probation period is earlier than the present
- D.
The policy's effective date is earlier than the present
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