AccidentHealth

The incontestable clause allows an insurer to

"contest a claim during the contestable period". The incontestable clause or provision specifies that after a certain period of time (usually two years from the issue date), the insurer no longer has the right to contest the validity of the life insurance policy so long as the contract continues in force.

S buys a $50,000 whole life policy with a $50,000 Accidental Death and Dismemberment rider. S dies 1 year later of natural causes. How much will the insurer pay the beneficiary?

$50,000

T took out a $50,000 life insurance policy with an Accidental Death and Dismemberment rider. Five years later, T commits suicide. How much will the insurer pay?

$50,000. Since the suicide happened outside of the contestable period The claim will be paid. However suicide is not considered an accident so only the 50,000 face value will be paid, not the accidental death and dismemberment rider.

Monthly premium individual health insurance policies must provide a grace period of at least

10 days

I'm insured let's notify and insurer of a medical claim within how many days after an accident?

20 days. Acclimate or policyholder must notify the insurance company of laws within 20 days, or as soon as reasonably possible as per notice of claims provision in health insurance policies

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

31

D, the beneficiary under her husband's AD&D policy, submits an accidental death claim on May 1, 2010 following his death. However, the company denies the claim on the basis that death was due to natural causes. She decides to talk to her attorney. What is the earliest date for taking legal action against the insurer?

60 days. An insurer must wait 60 days after filing a written proof of loss for a disability income clean or a DND claim prior to taking legal action against the insurer

The option that provides an additional death benefit for a limited amount of time at the lowest possible cost is called?

Accidental death and dismemberment rider. Normally these policies only listen to a specific age and because the loss as to be direct result of an accident, the policies are usually very expensive.

P is blinded in an industrial accident. Which provision of his life insurance policy will pay a stated benefit amount?

Accidental death or dismemberment Provision

L takes out a life insurance policy and dies 10 years later. During the claim process, the insurer discovers that L had understated her age on the application. Under the Misstatement of Age provision, the insurer will

Adjust death benefit to reduced amount

Which of the following statements describes what an accident and health policy owner may NOT do?

Adjust the premium payments

The consideration clause in an insurance contract contains what pertinent information?

Amount of premium payments and when they are due.

best statement that describes what the legal action provision of an accident and health policy requires?

And insured must wait at least 60 days(2months) after proof of loss has been submitted before a lawsuit can be filed.

When does a Probationary Period provision become effective in a health insurance contract?

At the policies inseption

P died 5 years later after purchasing a life policy. While investigating the claim, the insurer discovered material misrepresentations made by P during the application process. Which of these actions will the insurer take?

Beneficiary will be paid the death be if it bc policy is over the two year incontestable period

P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim?

Claim will be denied

A disability income Calcium recently submitted a claim for chronic neck problem that has now resulted in total disability. They're original neck injury occurred before the application with take in five years prior. The neck injury was never disclosed to the insurer at the time of application. How was insurer handle this claim?

Claim will be paid and coverage will remain in force

How do life insurance companies handle cases where the insured commits suicide within the contract's stated Contestable period?

Claims are denied under the suicide clause of the policy

Which of these actions is taken when a policyowner uses a Life Insurance policy as collateral for a bank loan?

Collateral assignment

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 statement regarding the misstatements of age provision is considered to be true?

Coverage Will be adjusted to reflect the insurance true age if a misstatement of age is discovered

Which of the following policy Visions stay producer does not have the authority to change the policy will waive any of its provisions?

Entire contract

Which provision prevents an insurer from changing the terms of the contract with the policyowner by referring to documents not found within the policy itself?

Entire contract

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 clause/provision

When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the

Entire contract provision

false statements about a GUARANTEED insurance option rider

Evidence Of insurability is required When the option is exercised

Insurance benefits not covered due to an act of war are

Excluded by the insurer

N is a student pilot with a large life insurance policy. Which of these features would limit the insurer's obligation in the event N was killed while flying as a student pilot?

Exclusion

When an insurer issues a policy that refuses to cover certain risks, this is referred to as a(n)

Exclusion

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

File in proof of loss.

Afternoon sure to give notice of loss, what was here she do if they sure it does not furnish forms

File written proof of loss. Up to the insured to prove a loss occurred

And insured is past due on his life insurance premium, but is still within the grace period. What will the beneficiary receive if the insured dies during the grace period?

Full face amount minus any past due premiums

With any insurance policy, what is the purpose of the Grace Period?

Gives policy owner additional time to pay past due premium

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

Grace Period

The agreement in an insurance contract that states a specific sum of money will be paid to a designated person upon an insured's death is called?

Insuring Agreement

Which of the following insurance policy provisions Specifies the benefits or services a policy will provide?

Insuring Clause

not considered to be a right given to a policy owner?

Midify a provision in the insurance contract

According to the time payment of claims provision, the insurance must pay disability income benefits no less frequently than which of the following options?

Monthly. must make payments atleast once a month.

The Notice of Claims provision requires a policyowner to

Notify an insurer of a claim within a specific time

M had an annual life insurance premium payment due January 1. She died January 10 without making the premium payment. What action will the insurer take?

Pay face amount minus past due premiums

The provision that defines to hold the insurer will pay Benefits to is called

Payment of claims

considered a mandatory provision?

Payment of claims.

What is the purpose of the time of payment of claims provision?

Prevents Delayed claim payments made by the insurer

Which of the following provisions Is not required in HMO contracts and certificates?

Seven day grace period, must be atleast 10 days

Statement best describes the purpose of the insuring clause in an insurance policy?

States the scopes and limit of the coverage

What should an insured do if the insurer doesn't send claim forms within the time period fourth and a health policies claim forms provision?

Submit the claim in any form, Insurance company is supposed to provide the insured with claim forms, it is up to the insured to notify the insurance company regardless. If the claim forms are not provided the insured can submit the claim using a napkin in a crayon, as long as all of the information is provided.

And it's covered by a term life policy and does not make the required minimum payment which was due August 1. And die September 15. What action will the insure take?

The claim will be denied

D was actively serving in the Marines when he was killed in an automobile accident while on leave. His $100,000 Whole life policy contains a War Exclusion clause. How much will D's beneficiary's receive?

The full face amount

The consideration Clause in an insurance policy indicates that a policy owner's consideration consists of a completed application and.....

The initial premium.

G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's policy, who is responsible for paying the medical bills?

The insured

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?

The insurer will adjust the benefit to what the premium paid would have purchased at insurer's actual age

In a life insurance policy, Which provision states with me so late policy options, beneficiary, and being there any financial benefits from the policy?

The owner, not insured has the right to select policy options, designate In mean beneficiary, and be the recipient of any financial benefits from the policy. This outlined in the owners rights provision.

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called

Time limit in certain defenses

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is

Time limit on certain defenses

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

Time limit on certain defenses

When a misrepresentation on a life insurance policy application is discovered, what action may an insurance company take?

Void the policy only if it is discovered during the contestable period and proven to be material

What does the ownership clause in a life insurance policy state?

Who the policy owner is and what rights the policy owner is entitled to.

What is the suicide provision designed to do?

safeguard the insurer from an applicant who is contemplating suicide