Health Insurance Exam-Illinois
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
Accepted questions on application to base premiums - ANSWER-age, family
composition, geographic region of residency, tobacco use
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 diability
Indeminity - ANSWER-Reimbursement
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
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
(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)
(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
Health Maintenance Organization (HMO's) entitle individuals - ANSWER-to obtain
medical services from hospital service providers that are part of the plan network
If HMO insured obtains servie from a hospital or physician service provider that is not in
network... - ANSWER-insured is not covered unless in an emergency situation
HMO's have the ______ restrictions on where the insured can go for service -
ANSWER-greatest/most limitations
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
Accepted questions on application to base premiums - ANSWER-age, family
composition, geographic region of residency, tobacco use
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 diability
Indeminity - ANSWER-Reimbursement
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
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
(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)
(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
Health Maintenance Organization (HMO's) entitle individuals - ANSWER-to obtain
medical services from hospital service providers that are part of the plan network
If HMO insured obtains servie from a hospital or physician service provider that is not in
network... - ANSWER-insured is not covered unless in an emergency situation
HMO's have the ______ restrictions on where the insured can go for service -
ANSWER-greatest/most limitations
