6 Health Insurance Policy Provisions

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?

Reinstatement

Insurers may request a hearing within _____ if their policy is rejected

20 days

According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?

31 days

M's insurance company denied A reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of a denial before the policy will be automatically placed back in force?

45 days

In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments:

After an insured has become totally disabled as defined in the policy

Health insurance benefits not covered due to an act of war are

excluded by the insurer in the contract provisions

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called

noncancellable

A disability income policy owner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken five years prior. The neck injury was never disclosed to the insured at the time of application. How are the insurer handle this claim?

Claim will be paid and coverage will remain in force

An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?

Consideration clause

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?

Entire Contract

Which of the following is not included in the policy face?

Exclusions

Which of the following provisions specifies how long a policy owners health coverage will remain in effect if the policy owner does not pay the premium when it is due?

Grace Period

If an individual has an Accidental Death and Dismemberment policy and dies, and autopsy can be performed in all these situations, except

In the state prohibit this by law

The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the

Insuring clause

Which of the following health insurance policy provisions specifies the healthcare services a policy will provide?

Insuring clause

J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase?

Noncancelable

With accident and health policy provision addresses pre-existing conditions?

Time limit on certain defenses

The Legal Actions provision of an insurance contract is designed to do all of the following EXCEPT

protect the producer

With Optionally Renewable Health policies, the insurer may

review the policy annually and determine whether or not to renew it

The insured pays premiums on an annual basis for an individual health insurance policy. What is the minimum number of days for the grace provision?

31