Chapter 6: Health

Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy? Past due premiums on a lapsed policy are waived and coverage is restored The insured is paid a monthly benefit to keep insurance premiums current in the event of total disability Premiums are waived after the insured has been unemployed for a specified time period Premiums are waived after the insured has been totally disabled for a specified time period

Premiums are waived after the insured has been totally disabled for a specified time period

Which of the following statements describes what an Accident and Health policyowner may NOT do? File a covered claim Assign ownership Cancel the coverage Adjust the premium payments

Adjust the premium payments

When does a Probationary Period provision become effective in a health insurance contract? At the policy's inception 30 days after the policy's inception When a claim is submitted When a covered loss occurs

At the policy's inception

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 Insuring clause Time Limit on Certain Defense provision Legal Contract clause

Entire Contract provision

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss

File written proof of loss

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period? Gives the policyowner additional time to pay overdue premiums Gives the policyowner additional time to file a lawsuit Gives the policyowner additional time to file a claim Gives the policyowner additional time to provide proof of loss

Gives the policyowner additional time to pay overdue premiums

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the Insuring clause Contestable clause Consideration clause Free-look provision

Insuring Clause

The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the... Entire Contract provision Consideration clause Benefit clause Insuring clause

Insuring clause

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? Free-look Reinstatement Grace Period Consideration

Reinstatement

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 reinsurer The insured The insurer The Guaranty Association

The insured

Which of the following BEST describes a short-term medical expense policy? Conditionally renewable Noncancellable Guaranteed renewable Nonrenewable

Nonrenewable

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is Grace Period Physical Examination and Autopsy Entire Contract Time Limit on Certain Defenses

Time Limit on Certain Defenses

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? Relation of earnings to insurance provision Change of occupation provision Conformity of state statutes provision Entire contract provisions

Change of occupation provision

Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due? Grace Period Consideration Waiver of Premium Reinstatement

Grace period

Which type of renew-ability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class? Conditionally Renewable Noncancellable Guaranteed Renewable Optionally Renewable

Guaranteed Renewable

Which of the following health insurance policy provisions specifies the health care services a policy will provide? Insuring clause Usual, Customary, and Reasonable clause Consideration clause Benefit clause

Insuring clause

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options? Annually Semiannually Quarterly Monthly

Monthly

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? Guaranteed Renewable Noncancelable Optionally Renewable Conditionally Renewable

Noncancelable

What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy? Premiums may increase at time of renewal Premiums may increase at any time Policy may be renewed at the discretion of the insured Policy may be amended by insurer at any time

Premiums may increase at time of renewal

Which Accident and Health policy provision addresses preexisting conditions? Proof of Loss Legal Actions Time Limit on Certain Defenses Payment of Claims

Time limit on Certain Defenses