Health Insurance Policy Provisions

premiums which can only be increased per rate class

A Guaranteed Renewable provision allows

within 15 days of receipt of the notice of loss

A health insurer MUST provide a proof of loss form

Consideration clause

An accident and health insurance policy's premium requirements are set forth in which of the following provisions?

bringing legal action against the insurer

An accident and health insurer has just received written proof of loss from one of its insureds. The insured must now wait 60 days before

$300

An insured files for an accident and health insurance policy claim eight days after the premium due date. The benefit payable is $500 and the overdue premium is $200. Assuming that the policy pays on a first-dollar basis and contains the unpaid premium provision, how much will the insurer pay?

notify the insurance company in writing

An insured is covered with a health insurance policy. If the insured would like to cancel the policy, he/she must

20

An insured must notify an insurer of a medical claim within how many days after an accident?

active military duty

Disability income insurance normally excludes coverage for disabilities that arise from

The unpaid premium may be subtracted from the reimbursement

How is an insured's accident and health claim handled by an insurer if it occurs during the policy's grace period?

specific reasons stated in the contract

Kelly purchases a health insurance policy issued on a conditionally renewable basis. The insurance company has a right to refuse renewal of the policy for

Reduce the benefit level

Omar is covered by a disability income policy. He is hurt while performing an occupation more hazardous than the occupation listed in his policy. The policy's change of occupation provision will have what effect?

monthly

Periodic health claim payments MUST be made at least

Benefits can be increased in the event of a covered claim

The Change of Occupation provision in a Disability Income policy states that, in the event the insured changes to a less hazardous occupation, which of the following may apply?

the first premium payment and the application

The insured's consideration given for a health insurance policy is

policy, endorsements, and attached papers constitute the "entire contract"

The standard provisions of an accident and health insurance policy require that the

Noncancelable

Tim is covered by an accident and health insurance policy that may not be changed in any way by the insurer up to a stated age, as long as the premiums are paid. What type of policy is this?

When not prohibited by state law

Under what circumstance does an accident and health insurer have the right to request an autopsy?

Insuring

Which health policy clause specifies the amount of benefits to be paid?

Noncancelable

Which of the following health insurance plans charges a premium that cannot be increased?

Entire Contract clause

Which of the following health insurance provisions requires that the application becomes part of the policy?

After a stated period of time, claims cannot be denied due to material misrepresentation on the application

Which of the following statements accurately describes the "time limit on certain defenses"?

The agent doesn't have the authority to change the policy or waive its provisions

Which statement concerning the Entire Contract provision in an individual accident and health insurance policy is TRUE?

Insurance company

Who is protected with the "other insurance with this insurer" provision?

The insurer or the insured

Who may terminate coverage under a cancelable health insurance policy?

the insurer was not notified prior to the claim that the insured has other health coverage

james is covered with health insurance by two different insurers. The "insurance with other insurers" provision in an individual health insurance policy allows an insurer to pay benefits to the insured on a pro-rata basis when