Podcast
Questions and Answers
Which of the following BEST describes how pre-admission certifications are used?
Which of the following BEST describes how pre-admission certifications are used?
- To limit patient choice
- To prevent nonessential medical costs (correct)
- To allow unnecessary medical procedures
- To increase hospital admissions
Pre-hospitalization authorization is considered an example of?
Pre-hospitalization authorization is considered an example of?
managed care
How are the $3,000 benefit payments from a Disability Income policy taxable if T's employer paid the premiums?
How are the $3,000 benefit payments from a Disability Income policy taxable if T's employer paid the premiums?
Benefits are taxable to T
Which type of plan normally includes hospice benefits?
Which type of plan normally includes hospice benefits?
Which mode of payment is NOT used by health insurance policies?
Which mode of payment is NOT used by health insurance policies?
Substandard applicants are never declined by underwriters.
Substandard applicants are never declined by underwriters.
How much of P's monthly income from Individual Disability Income policy is subject to federal income tax?
How much of P's monthly income from Individual Disability Income policy is subject to federal income tax?
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?
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?
What is the next step the insurance company will take after an agent issues a conditional receipt?
What is the next step the insurance company will take after an agent issues a conditional receipt?
What actions should an agent take if a customer wants to apply for an insurance policy?
What actions should an agent take if a customer wants to apply for an insurance policy?
What action should Agent J take if the premium check is made out to J instead of the insurance company?
What action should Agent J take if the premium check is made out to J instead of the insurance company?
Information obtained from a phone conversation to the proposed insured can be found in which report?
Information obtained from a phone conversation to the proposed insured can be found in which report?
Which of the following actions would the insurance company NOT take after receiving an MIB report showing a stroke not disclosed in the application?
Which of the following actions would the insurance company NOT take after receiving an MIB report showing a stroke not disclosed in the application?
Which of the following are NOT managed care organizations?
Which of the following are NOT managed care organizations?
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Study Notes
Health Insurance Underwriting
- Pre-admission certifications serve to prevent unnecessary medical expenses before hospital admission.
Managed Care
- Pre-hospitalization authorization is a managed care practice requiring insurer approval for hospital entry to manage costs.
- Managed care plans typically include hospice benefits, supporting end-of-life care.
Disability Income Taxation
- Disability income benefits received from a policy fully paid by an employer are taxable to the recipient.
- If a policyholder paid entirely for their own Disability Income policy, the benefits are not subject to federal income tax.
Underwriting Classifications
- Substandard applicants may be rated below average but can also be outright declined by underwriters.
- Insurance companies may reassess applications from individuals with conditions like diabetes but will not issue a policy with altered claims payment provisions.
Application Process
- After taking a Disability Income application and collecting premium, insurers will perform standard underwriting procedures to evaluate risk.
- Agents must complete insurance applications carefully, review details with clients, and send the finished application to the insurer for processing.
Payment Issues
- If an agent receives a check made out to themselves instead of the insurance company, they must return it, collect a correctly made out check, and resend it to the insurer.
Reports and Discrepancies
- Information from phone conversations with a proposed insured is compiled in an inspection report.
- If an applicant fails to disclose a previous medical condition like a stroke, the insurance company would not notify the MIB of a decline.
Managed Care Organizations
- Examples of managed care organizations include Point-of-Service (POS), Preferred Provider Organization (PPO), and Health Maintenance Organization (HMO).
- The Medical Information Bureau (MIB) is not classified as a managed care organization.
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