NY Life and Health

A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claims

The claim is denied if the policy contains the Illegal Occupation provision This optional provision specifically excludes coverage for injuries incurred while performing illegal acts. The insurer will not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation

Which of the following will vary the length of the grace period in health insurance policies

The mode of premium payment The grace period is 7 days on a policy with a weekly premium mode,; 10 days on a monthly premium mode; 31 days on others.

In respect to the consideration clause, which of the following is consideration on the part of the insurer?

Promising to pay in accordance with the contract terms The consideration clause requires the insurer to promise to pay in accordance with the terms of the contract

When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees

To renew the policy until the insured has reached age 65 The guaranteed renewable provision is similar to the noncancellable provision, with the exception that the insurer can increase the policy premium on the policy anniversary date. As with the noncancellable policy, coverage is generally not renewable beyond the insured's age of 65

An insured owes his insurer a premium payment. Since then, he incurs medical expenses. The insurer deducts the unpaid premium amount from the claim amount and pays the insured the difference. What provision allows for this?

Unpaid Premium If a premium is past due and an insurer owes a claim payment, the amount of the premium will be deducted from the amount of the claim.

An insured has a heart attack 40 days after the new health insurance policy goes into effect. He has a quadruple bypass surgery and a long hospital stay. As a result, the insurer cancels the policy with a written notice 80 days after the effective policy date. Which of the following is true

The insurer is cancelling the insured's policy on illegal grounds. An insurer can cancel a policy within 90 days of the effective coverage date, but it cannot cancel coverage based on a claim that was made prior to cancellation