Health Insurance Policy Provisions - Chapter Exam Answers

What type of renewability guarantees premium rates and renewability?

Guaranteed renewable

Required Provision 3 states that the minimum grace period for all policies (except those with monthly or weekly premium modes) is

31 days

The Notice of Claim Provision states that the insured notify the insurance company within __ days of a claim.

20

An insurance pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

31

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

Bart is injured and provides notice of a health claim to his insurer. He later receives the required claims forms. Within how many days of the loss must Bart file proof of loss with the insurance company?

90

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

E signed the policy and submitted it to the company without completing medical history questions and paying the initial premium. E is not insured. Which of the following details the conditions that E did not meet?

Consideration Clause

Which of the following health insurance provisions specifies the health care services a policy will provide?

Insuring clause

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 amount of time

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

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

anita is an office clerk at the time she purchases a Disability income policy. she later changes her career to a king crab fisherman. if she ever becomes injured on the boat, the Change of Occupation provision states that the insurer can

adjust the benefits

Which of the following statements describes what an Accident and Health policywner may NOT do

adjust the premium payments

Which of the following statements is NOT correct?

agents are allowed to waive certain policy provisions

Which of the following statements BEST describes what the Legal Actions Provision of an Accident and Health policy requires?

an insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed

After the insurance company receives a written request, an insured may have health benefits paid to

anyone designated by the insured

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

at the policy's inception

A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of the application. How will the insurer handle this claim?

claim will be paid and the coverage will remain in force

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

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the

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?

monthly

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called

noncancellable

Which of the following BEST describes a short-medical expense policy?

nonrenewable

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning

november 1

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

payment of claims

Which of these is considered a mandatory provision?

payment of claims

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 the time of renewal

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

prevents delayed claim payments made by the insurer

The Notice of Claims provision requires a policyowner to

provide proof of loss to an insurer within a specified time

Which of the following statements describes the purpose of the insuring clause in Health and Accident policies?

states the scope and limits of coverage

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

Amy owns a disability income policy with a noncancellable renewal provision. Which of the following is guaranteed in her policy?

the coverage and premium rate are guaranteed

Which of the following statements about a noncancellable policy is FALSE?

the premium rate CAN be increased over time

Which Accident and Health policy provision addresses preexisting conditions?

time limit on certain defenses

If an individual has an AD&D policy and dies, an autopsy can be performed in all these situations EXCEPT

when the state prohibits this by law

According to Required Provision 4, when an insured applies for reinstatement of a health policy and receives a conditional receipt, how long does the insurer have to approve or deny?

within 45 days of the date of application