Health Insurance Exam-Illinois/ 138 Q&A/ A+ Score
Solution.
Errors and Changes on the Application - Answer: if error on application, underwriter may
require it be corrected and changes must be approved and initialed by the applicant
Medical information bureau (MIB) report - Answer: it is a clearing house for medical
information for insurance companies that belong to it
Credit Report - Answer: Determines if total benefits are reasonable compared to applicant's
income so as to avoid disincentive
Inspection report - Answer: to verify that the producer completed the application accurately
and completely is the first purpose of an inspection report
Incontestability Clause - Answer: after the policy has been in effect two years the insurance
company cannot contest a policy doe to any misstatement or concealment unless it can prove
fraud
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,(tax) premiums on ind. hospital/medical expense policies - Answer: can sometimes be tax
deducted; depends on whether an ind is self-employed and if ind. itemizes on tax returm
(tax) premiums paid by an ind. on ind. diability income policies - Answer: usually cannot be tax
deducted (non qualified)
(tax) ind. expense policies, ind disability income policies, are usually - Answer: tax free and have
no tax on the benefits
(tax) premiums paid by employer usually - Answer: can be tax deducted by the employer (tax
qualified)
Risk type expenses - Answer: cannot be planned and is unintended
Purpose of health insurance is - Answer: to protect a insured against the risk of financial loss
he/she cannot individually afford caused by illness, injury, or disability
Indemnity - Answer: Reimbursement
Coordination of Benefits provision - Answer: is in some health insurance policies; allows
insurance companies to reduce benefits so that the insured will be paid no more that his/her
actual loss. prevents the insured from collecting under multiple policies more than his/her
actual loss
Coordination policy - Answer: is a policy that includes a coordination of benefits provision
Non-coordinating policy - Answer: is a policy that does not include a coordination of benefits
provision
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, Accepted questions on application to base premiums - Answer: age, family composition,
geographic region of residency, tobacco use
unacceptable question on application to base premiums - Answer: past medical history, gender,
occupation, ethnicity
Attending Physician Statement - Answer: the underwriter contacts physician who has treated
the applicant in the past for an evaluation; it's purpose is to confirm information on the medical
report
(tax) group expense coverage is usually - Answer: no tax on benefits (tax free)
Private Health Insurance Companies were originally established to - Answer: issue risk
indeminity policies
Private Health Insurance Companies have the _____ restrictions to where the insured can go for
service - Answer: fewest
Service Organizations - Answer: the subscriber is entitled to obtain hospital/medical services
from any hospital/doctor service provider that is a member of the network; outside network
will not be covered
Blue Cross originally assured payment of - Answer: hospital charges
Blue Shield originally assured payment of - Answer: physician's charges
Preferred Provider Organizations (PPO's) - Answer: provides medical services at negotiated
discounted rates and offer lower deductibles and co-insurance requirements to apply if the
insured receives service from a hospital in network
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Solution.
Errors and Changes on the Application - Answer: if error on application, underwriter may
require it be corrected and changes must be approved and initialed by the applicant
Medical information bureau (MIB) report - Answer: it is a clearing house for medical
information for insurance companies that belong to it
Credit Report - Answer: Determines if total benefits are reasonable compared to applicant's
income so as to avoid disincentive
Inspection report - Answer: to verify that the producer completed the application accurately
and completely is the first purpose of an inspection report
Incontestability Clause - Answer: after the policy has been in effect two years the insurance
company cannot contest a policy doe to any misstatement or concealment unless it can prove
fraud
Page 1 of 16
,(tax) premiums on ind. hospital/medical expense policies - Answer: can sometimes be tax
deducted; depends on whether an ind is self-employed and if ind. itemizes on tax returm
(tax) premiums paid by an ind. on ind. diability income policies - Answer: usually cannot be tax
deducted (non qualified)
(tax) ind. expense policies, ind disability income policies, are usually - Answer: tax free and have
no tax on the benefits
(tax) premiums paid by employer usually - Answer: can be tax deducted by the employer (tax
qualified)
Risk type expenses - Answer: cannot be planned and is unintended
Purpose of health insurance is - Answer: to protect a insured against the risk of financial loss
he/she cannot individually afford caused by illness, injury, or disability
Indemnity - Answer: Reimbursement
Coordination of Benefits provision - Answer: is in some health insurance policies; allows
insurance companies to reduce benefits so that the insured will be paid no more that his/her
actual loss. prevents the insured from collecting under multiple policies more than his/her
actual loss
Coordination policy - Answer: is a policy that includes a coordination of benefits provision
Non-coordinating policy - Answer: is a policy that does not include a coordination of benefits
provision
Page 2 of 16
, Accepted questions on application to base premiums - Answer: age, family composition,
geographic region of residency, tobacco use
unacceptable question on application to base premiums - Answer: past medical history, gender,
occupation, ethnicity
Attending Physician Statement - Answer: the underwriter contacts physician who has treated
the applicant in the past for an evaluation; it's purpose is to confirm information on the medical
report
(tax) group expense coverage is usually - Answer: no tax on benefits (tax free)
Private Health Insurance Companies were originally established to - Answer: issue risk
indeminity policies
Private Health Insurance Companies have the _____ restrictions to where the insured can go for
service - Answer: fewest
Service Organizations - Answer: the subscriber is entitled to obtain hospital/medical services
from any hospital/doctor service provider that is a member of the network; outside network
will not be covered
Blue Cross originally assured payment of - Answer: hospital charges
Blue Shield originally assured payment of - Answer: physician's charges
Preferred Provider Organizations (PPO's) - Answer: provides medical services at negotiated
discounted rates and offer lower deductibles and co-insurance requirements to apply if the
insured receives service from a hospital in network
Page 3 of 16
