UHC exam

elements of a contract

agreement, consideration, competent parties, legal purpose

acceptance

when an insurers underwriter approves the app and issues a policy

consideration

something of value that each party gives to the other

insurers consideration

promise to pay for losses

insured consideration

payment of premium and statements on the app

parties of a contract

must be capable of entering into a contract in the eyes of the law. be of legal age, mentally competent, and not under drugs or alcohol

to ensure legal purpose of a policy

insurable interest and consent

insurable interest

required at the time of policy issuance

warranty

absolutely true statement upon which the validity of the insurance policy depends

representations

statements believed to be true to the best of ones knowledge, but they are not guaranteed to be true

misrepresentations

untrue statements on the app and could void the contract

material misrepresentation

statement that, if discovered, would alter the underwriting decision of the insurance company

representations are:

statements believed to be true

conditional contract

requires that certain conditions must be met by the policy owner and the company in order for the contract to. be executed and before each party fulfills its obligations

unilateral contract

only one of the parties to the contract is legally bound to do anything. insured makes no legally binding promises, but an insurer is legally bound to pay losses by a policy in force c

contract of adhesion

is prepared by one of the parties (insurer) and accepted/rejected by the other party (insured).

aleatory

an exchange of unequal amounts or values

notice to the applicant

must be issued to all applicants for health insurance coverage. informs applicant that a credit report will be ordered

it is the agents responsibility to make sure that an application for insurance is ____ and ___ to the best knowledge of the applicant

complete, accurate

signatures

proposed insured, policyowner, and agent

ways to correct an app

start over or draw a line through the incorrect answer and insert correct one

any changes on the app must be ___

initialed by the applicant or insured

a ____ is collected for a health insurance policy and sent to the insurer with the app

initial premium

when a premium did not accompany the app for insurance, upon delivery, the agent must collect the premium and obtain a _____ from the applicant before releasing the policy

statement of good health

attending physician report (APS)

to be sent to applicants dr if necessary. best source for accurate info on the apps medical history

medical exam report

when required, are conducted by a physician or paramedics at insurance companies expense. not usually required but more common with life insurance

medical info and consumer reports

policies with higher amounts of coverage/app raising questions concerning health, underwriter may require thispa

MIB Group

membership corp owned by member insurance companies. non profit. collects, maintains, and makes avilable

insurers cannot refuse coverage solely on the bases of adverse info on an ___

MIB report

fair credit reporting act

establishes procedures that consumer-reporting agencies must follow in order to ensure that records are confidential, accurate, relevant, and properly used

consumer reports

include written and/or oral info regarding a consumers credit, character, reputation, or habits collected by a reporting agency from employment records, credit records, and more

investigative consumer reports

provide info on the consumers character, reputation and habits. cannot be made unless consumer is advised in writing about the report within 3 days of the date the report was requested

insurance applicants must be notified ____ whenever insurers request investigative consumer reports

in writing

HIPPA

protected info includes all “individually identifiable health info”

Protected health info

protected info includes all “individually identifiable health info” held or transmitted by a covered entity or its business associate in any form or media, whether electronic, paper, or oral

once the delivery of a policy is made….

the free-look period begins

if a policy is issued with any changed or amendments ….

the agent is required to explain these changes and obtain the insured signature acknowledging receipt of these amendments

there cannot be any ___ between the existing coverage and replacement coverage

coverage gap

pre-existing condition

a medical condition for which the insured sought medical advice or treatment within a specific period of time prior to the policy issue conditions covered under the current policy may not be covered under the new policy due to pre existing conditions