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Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5

Underwriting for a large group (101 or more employees) relies most heavily on:

Select an option to reveal the answer and the full 3-part explanation — free, no signup.

Answer & full 3-part explanation (select an option above, or peek)

Why A is correct

For large groups, the insurer prices coverage primarily on the group's own claims experience, industry classification, and demographic characteristics such as age and gender distribution. Because the group is large enough for credible loss data, individual medical underwriting is neither necessary nor permitted. This is a distinct underwriting approach from small groups, where community rating and guaranteed issue dominate. The distinction is covered under the large-group underwriting considerations in AH-III.B.2.

Why the other options are wrong

  • B) Large groups are not underwritten on each employee's medical history; experience rating uses group-wide data.
  • C) The owner's history is immaterial to pricing a large group; group experience determines the rate.
  • D) Credit scores are not a basis for rating large group health coverage.

Memory hook

Big group, big data: the group's own claims set the premium.

Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5

When underwriting a large group health plan, an insurer most heavily relies on:

Select an option to reveal the answer and the full 3-part explanation — free, no signup.

Answer & full 3-part explanation (select an option above, or peek)

Why B is correct

For large groups, underwriting is based primarily on the group's aggregate experience: prior claims history, group size, and the occupational classes represented. Because a large group spreads risk across many lives, individual medical evidence is generally not required, and coverage is issued based on the group's overall loss experience. Small groups, by contrast, are subject to more standardized rules and community rating. Experience rating is what makes large-group coverage attractive and stable.

Why the other options are wrong

  • A) Individual medical questionnaires are typical of small group and individual underwriting; large groups rely on aggregate claims data.
  • C) The health of the owner is not the basis for pricing a large group, which uses the experience of the entire group.
  • D) Dependent age and gender profiles are part of rating inputs, but the core of large group underwriting is the group's own claims experience and composition.

Memory hook

Large groups are rated on their own track record: claims, size, occupations. No one is put under the microscope.

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