11/2 Quiz:

Which health insurance provision allows an overdue premium to be subtracted from a claim?

Any premium due and unpaid may be deducted from the payment of a claim. The correct answer is: Unpaid premium

Marcy cancels her health insurance policy during the middle of the policy term. What will the insurer do?

If the insured cancels a policy, the insurer may keep the earned premium and a portion of the unearned premium. The insured will receive a refund of a portion of the unearned premium on a short rate basis. The correct answer is: Return a portion of Marcy's unearned premiums on a short rate basis

Joel cancels his health insurance policy. How will the insurer return his unearned premium?

If the insured cancels the policy, the unearned premium will be returned on a short rate basis. The correct answer is: Short rate

If the insurer cancels a health insurance policy during the middle of the policy term, how will the premiums be returned to the policyholder?

Pro rata return of premium is used when the insurer cancels a health insurance policy. _Pro rata_ means the insurer's earned premium is kept, and the unearned premium is returned to the insured. The correct answer is: Pro rata return

In which of the following types of health insurance policies is the change of occupation provision particularly important?

The change of occupation provision is particularly important in disability income policies in which the insured receives a portion of their earnings during disability. The correct answer is: Disability income

Which health insurance provision allows the insurer to adjust policies so they are in alignment with state laws?

The conformity with state statutes provision assures that accident and health insurance policies are always in alignment with state laws. The correct answer is: Conformity with state statutes

Betty accidentally misstates her age on her application for an individual health insurance policy. The insurer discovers this error after the incontestability period. What will the insurer do?

The insurer will adjust Betty's benefits to match her correct age. The correct answer is: The insurer will adjust her policy benefits.

The insurer discovers that Veronica misstated her age on the health insurance policy application. What will the insurer do?

The insurer will adjust Veronica's benefits to match her correct age. The correct answer is: Adjust the policy benefits

What will the insurer do if an insured submits a claim for treatment of an injury incurred while the insured was under the influence of non-prescription narcotics?

A claim for loss or injury incurred while the insured is intoxicated or under the influence of non-prescription narcotics may be denied by the insurer. The correct answer is: The insurer may deny payment of the claim

Mary submits a claim for an injury that she incurred while under the influence of non-prescription narcotics. What will her insurer do?

A claim for loss or injury incurred while the insured is intoxicated or under the influence of non-prescription narcotics may be denied by the insurer. The correct answer is: The insurer may deny payment of the claim.

What action will the insurer take if the insured has misstated their age on a health insurance application?

A misstatement of age does not void a policy. The benefits are adjusted accordingly. All amounts payable under the policy will be modified to what the premiums would have purchased at the correct age. The correct answer is: Adjust the benefits accordingly

Ben has a past due premium of $387 and a pending claim of $642. Which of the following is true?

According to the unpaid premium optional provision, the insurer may deduct Ben's unpaid premium from a claim payment. Ben's claim payment is reduced to $255 ($642 _ $387 = $255). The correct answer is: The insurer may deduct the amount of the past due premium from the pending claim, thereby reducing Ben's claim payment to $255.

Harold has a past due premium of $150 and a pending claim of $375. Which of the following is true?

According to the unpaid premium optional provision, the insurer may deduct Harold's unpaid premium from a claim payment. The correct answer is: The insurer may deduct the amount of the past due premium from the claim.

Eric, an executive assistant, has a disability income policy with the change of occupation provision. Eric quits his office job and becomes a construction worker. What would happen to Eric's policy if he becomes disabled after the job change?

If Eric becomes disabled after having changed occupations to one classified as more hazardous , the insurer will pay only the portion of the indemnities provided in the policy as the premium paid would have purchased-at the rates and within the limits fixed by the insurer-for the more hazardous occupation. The correct answer is: The insurance company would pay the amount of disability income benefits that the premium purchased would have covered for Eric's more hazardous occupation.

Erin cancels her individual health insurance policy before the end of the policy term. The insurer will:

If the insured cancels a policy, the insurer may keep the earned premium and a portion of the unearned premium. The insured will receive a refund of a portion of the unearned premium on a short rate basis. The correct answer is: Return a portion of Erin's unearned premiums on a short rate basis

Bob works as a coal miner. He decides to change jobs and become an insurance agent. He notified his insurance company about his job change. According to the change of occupation provision, the insurer will:

Since Bob's new job is less hazardous, the insurer will decrease his premiums. The correct answer is: Lower his premiums

Josh works as a firefighter. He decides to quit his dangerous job to become an administrative assistant for Samantha, the head of a top advertising firm. According to the change of occupation provision, the insurance company will:

Since Josh's new job is less hazardous, the insurer will decrease his premiums. The correct answer is: Decrease his health insurance premium

Which of the following health insurance provisions prevents malingering?

The average earnings clause prevents the insured from malingering, which is intentionally staying disabled in order to continue to receive disability income benefits. Insurers don't want it to be profitable for insureds to remain disabled. The correct answer is: Relation of earnings to insurance _ average earnings clause

The average earnings clause for health insurance policies states that an insurer may not reduce total monthly benefits to less than:

The average earnings clause states that an insurer may not reduce the total monthly amount of benefits payable to less than $200. The correct answer is: $200

Steven, age 53, purchased a disability income policy when he was 33. When he applied for the policy, he stated his age as 23 on the application. Steven submits a claim and the insurance company discovers the error. What action will the insurance company take?

The insurance company will pay a decreased amount of benefits based on the premiums Steve should have been paying, had his correct age been stated in the policy application. The correct answer is: Pay the claim, but a decreased amount of benefits based on the premiums Steven should have paid, had his correct age been stated in the application

According to the cancelation provision for health insurance policies, the insurer has ____ days from the date written notice is delivered to the insured, to cancel a policy.

The insurer may cancel the policy at any time by written notice delivered to the insured stating cancelation is not effective until at least five days later. The correct answer is: 5

Which health provision states, "The insurer is not liable for any loss or injury in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician?"

The intoxicants and narcotics optional health provision states that the insurer is not liable for any loss or injury in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician. The correct answer is: Intoxicants and narcotics

All of the following are required provisions for health and accident policies, EXCEPT:

The misstatement of age provision is an optional health and accident policy provision. The correct answer is: Misstatement of age

Which of the following is not a mandatory NAIC health insurance provision?

The misstatement of age provision is not a mandatory NAIC health insurance provision. The correct answer is: Misstatement of age

The following provisions are required in individual accident and health insurance policies issued, EXCEPT:

The misstatement of age provision is optional. It states that if the insured's age has been misstated, any benefits will be based on the coverage the premium would have purchased at the correct age. The correct answer is: Misstatement of age

When periodic claim payments are required under a long-term disability income policy, an insurer must make payments to an insured at least once every:

The periodic claim payments provision requires that payments be made at least once a month. The correct answer is: Month

All of the following are optional provisions under the NAIC Uniform Provisions Law, EXCEPT:

The physical examination and autopsy provision is required. The correct answer is: Physical examination and autopsy

Which of the following is not an optional provision under the NAIC Uniform Provisions Law?

The physical examination and autopsy provision is required. The correct answer is: Physical examination and autopsy

Who does the "other insurance in this insurer" provision protect?

The purpose of the "other insurance in this insurer" provision is to prevent the insured from making a profit from insurance claims. The correct answer is: The insurer

What is the primary purpose of the "other insurance with this insurer" health insurance provision?

The purpose of the "other insurance with this insurer" provision is to prevent the insured from making a profit by seeking medical care and filing claims. In these cases, the insured is unnecessarily over-insured. The correct answer is: Prevent the insured from making a profit from health insurance claims