Chapter 6 Health Insurance Policy Provisions
Periodic health claim payments MUST be made at least
Monthly
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss
15
An insured must notify an insurer of a medical claim within how many days after an accident?
20 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 the denial before the policy will be automatically placed back in force?
45 days
Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions?
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 The Entire Contract The Entire Contract provision states that the health insurance policy, together with a copy of the signed application and attached riders and amendments, constitutes the entire contract.
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?
File written proof of loss
Which of the following health insurance policy provisions specifies the health care services a policy will provide?
Insuring Clause
Which of the following BEST describes a short-term medical expense policy?
Nonrenewable
Which of these is considered a mandatory provision?
Payment of Claims
Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?
Premiums are waived after the insured has been totally disabled for a specified time period
What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?
Premiums may increase at time of renewal
Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT?
Premiums normally increase at time of renewal
What is the purpose of the Time of Payment of Claims provision?
Prevents delayed claim payments made by the insurer. The purpose of the Time of Payment of Claims provision is to prevent the insurance company from delaying claim payments.
What must the policyowner provide to the insurer for validation that a loss has occurred?
Proof of Loss
The Legal Actions provision of an insurance contract is designed to do all of the following, EXCEPT:
Protect the Producer
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
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 on Certain Defenses
An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the
insurer dates the policy
The Notice of Claims provision requires a policyowner to
notify an insurer of a claim within a specified time