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Flashcards in Chapter 6 Health Deck (9):
1

Pre-hospitalization authorization is considered an example of

managed care. Pre-hospitalization authorization is the insurer's approval of an insured entering a hospital. Many health policies require this as part of an effort to manage costs.

2

Which of the following are NOT managed care organizations?

Point-of-Service plan (POS)

Preferred Provider Organization (PPO)

Medical Information Bureau (MIB)

Health Maintenance Organization (HMO)

Medical Information Bureau (MIB)

3

Which of the following statements about the classification of applicants is INCORRECT?

Substandard applicants are never declined by underwriters

Substandard applicants are occasionally declined by underwriters

Preferred risk applicants typically have better premium rates than standard risk applicants

An applicant can be classified as substandard risk because of a hazardous job

Substandard applicants are never declined by underwriters

4

Which of the following BEST describes how pre-admission certifications are used?

Used to assist in underwriting

Used to prevent nonessential medical costs

Used to minimize hospital lawsuits

Used to help process claims

Used to prevent nonessential medical costs

5

Which type of plan normally includes hospice benefits?

Short-term disability plans

Group life plans

Workers' Compensation

Managed care plans

Managed care plans

6

A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take?

Send the initial premium back to the applicant

Send a notice to the applicant that the coverage was declined

Send a notice to the MIB that the applicant was declined

Send a notice to the agent that the applicant was declined

Send a notice to the MIB that the applicant was declined

7

An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to

determine if the applicant is an acceptable risk by completing standard underwriting procedures

8

Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a Disability Income policy?

Issue the policy with a diabetes exclusion

Issue the policy with an altered Time of Payment of Claims provision

Issue the policy with a rating

Decline the applicant

Issue the policy with an altered Time of Payment of Claims provision

9

Which mode of payment is NOT used by health insurance policies?

Monthly premium

Annual premium

Single premium

Semi-annual premium

Single premium