(Health) 6 - Health Insurance Policy Provisions

The provision that defines to whom the insurer will pay benefits to is called

Payment of Claims The Payment of Claims provision in a Health Insurance policy states to whom claims will be paid.

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 The Waiver of Premium provision waives the payment of premiums after the insured has been totally disabled for a specified period of time.

Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT?

Premiums normally increase at time of renewal A Guaranteed Renewable Health Insurance policy can have increasing premiums 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 should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?

Submit the claim in any form If forms are not furnished, the insured should submit the claim in any form, which must be accepted by the company as adequate proof of loss.

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 This provision limits the period during which an insurer can deny a claim based on a misstatement made by the insured.

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

excluded by the insurer in the contract provisions An exclusion is a provision that entirely eliminates coverage for a specified risk, such as an act of war or aviation.

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

protect the producer The Legal Actions provision is designed to do all of these EXCEPT protect the producer.

With Optionally Renewable Health policies, the insurer may

review the policy annually and determine whether or not to renew it With an Optionally Renewable policy, the insurance company may review the policy annually and choose whether or not to renew it.

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

Monthly The time of payment for claims is usually specified in different policies as 60 days, 45 days, or 30 days. However, if the claim involves disability income benefits, the benefits must be paid not less frequently than monthly.