Questions and Answers
What differentiates Investigative Consumer Reports from regular Consumer Reports?
How long does a consumer have to be notified about an Investigative Consumer Report after it has been requested?
What is included in Consumer Reports according to the information provided?
What must be provided to the consumer upon request concerning an Investigative Consumer Report?
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What must insurers do when requesting Investigative Consumer Reports?
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Which of the following statements is true regarding the reporting of consumer behaviors?
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Who is responsible for the costs of a medical examination requested by an insurer?
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What must insurers obtain in order to require an applicant to take an HIV test?
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Under what condition is an adverse underwriting decision based on symptoms acceptable?
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Which type of reports fall under the Fair Credit Reporting Act?
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What is a requirement of consumer-reporting agencies under the Fair Credit Reporting Act?
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What is the primary focus of underwriting for HIV or AIDS?
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What type of approval is required for insurers before using HIV testing results?
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Which of the following is NOT a reason the Fair Credit Reporting Act protects consumers?
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What does PHI stand for in the context of HIPAA?
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Which of the following forms of information can be considered PHI?
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Under HIPAA, what is required for a covered entity to disclose health information not related to treatment?
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Which of these statements accurately describes individually identifiable health information?
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What kind of information is NOT typically classified as PHI?
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Which of the following best describes protected health information (PHI)?
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What is required for a covered entity to disclose health information not related to treatment or payment?
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Which of the following information is classified as individually identifiable health information?
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Under HIPAA, which of the following statements is true?
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What types of information are included in the definition of PHI?
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Study Notes
Medical Exam Report
- Medical examinations for insurance are conducted at the insurer's expense, often required for life insurance underwriting rather than health insurance.
- Insurers are responsible for costs associated with requested medical exams.
- Written consent is mandatory for HIV tests, outlining the test's purpose and confidentiality of results.
- Underwriting decisions related to HIV or AIDS must not be unfairly discriminatory—an adverse decision cannot solely be based on symptoms without confirmed diagnosis.
- Strict confidentiality must be maintained by insurers regarding HIV-related test results and diagnoses.
Fair Credit Reporting Act
- Established procedures for consumer-reporting agencies to ensure confidentiality, accuracy, and relevance of records.
- Protects consumers from the distribution of inaccurate or outdated personal/financial information.
- Risk acceptability is assessed through factors directly linked to potential loss, potentially supplemented by external information requests.
- Reports are categorized into Consumer Reports and Investigative Consumer Reports, both requiring legitimate business purposes for use.
Consumer Reports
- Include information on a consumer's credit, character, reputation, or habits, gathered from employment records and public sources.
Investigative Consumer Reports
- Provide similar information as consumer reports but are obtained through investigations and interviews with individuals associated with the consumer.
- Consumers must be informed in writing within 3 days of request; they have the right to request more information, which must be provided within 5 days.
Know This
- Insurance applicants must receive written notification whenever investigative consumer reports are requested by insurers.
HIPAA Privacy
- The Privacy Rule of HIPAA protects "individually identifiable health information," designated as protected health information (PHI).
- PHI includes demographic data related to past, present, or future health conditions or payment details capable of identifying individuals.
- Written authorization from individuals is required to disclose information not related to treatment, payment, or healthcare operations.
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Description
This quiz covers key aspects of medical examinations required for insurance and important principles of the Fair Credit Reporting Act. It highlights the responsibilities of insurers, the importance of consent and confidentiality in medical testing, particularly relating to HIV, and consumer protection in credit reporting. Test your knowledge on these essential topics for a better understanding of insurance practices and consumer rights.