6- Health insurance

S buys a $50,000 whole life policy with a $50,000 Accidental Death and Dismemberment rider. S dies 1 year later of natural causes. How much will the insurer pay the beneficiary?

$50,000

Monthly premium individual health insurance policies must provide a grace period of at least...

10 days

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

20

An insured 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 days

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

which of the following provisions is not required in HMO contracts or certificates?

7 day grace period

B purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this?

Guaranteed insurability rider

D, the beneficiary under her husband's AD&D policy, submits an accidental death claim on May 1, 2010 following his death. However, the company denies the claim on the basis that death was due to natural causes. She decides to talk to her attorney. What is the earliest date for taking legal action against the insurer?

July 1, 2010

P is the insured on a participating life policy. Which statement is true if P's premiums are waived due to a disability?

P will receive declared dividends

Which of these is considered a mandatory provision?

Payment of claims

P is blinded in an industrial accident. Which provision of his life insurance policy will pay a stated benefit amount?

accidental death and dismemberment provision

The option that provides an additional death benefit for a limited amount of time at the lowest possible cost is called

accidental death and dismemberment rider

B owns a Whole Life policy with a guaranteed insurability option that allows him to purchase, without evidence of insurability, stated amounts of

additional whole life coverage at specified times

in insurance policies, a waiver of premium provision keeps the coverage in force without premium payments...

after an insured has become totally disabled as defined in the insurance policy

the consideration clause in an insurance contract contains what pertinent information?

amount of premium payments and when they are due

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

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

at the policy's inception

the guarantee of insurability option provides a long-term care policy owner the ability to...

buy additional coverage at a later date

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?

change of occupation provision

N is covered by a Term Life policy and does not make the required premium payment which was due August 1. N dies September 15. What action will the insurer take?

claim will be denied

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

An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?

consideration clause

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?

entire contract

Which provision prevents an insurer from changing the terms of the contract with the policyowner by referring to documents not found within the policy itself?

entire contract

which of the following policy provisions states that the producer does not have the authority to change the policy or waive any of its provisions?

entire contract

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

which of these statement about a guaranteed insurability option rider is not true?

evidence of insurability of required when the option is exercised

insurance benefits not covered due to an act of war are...

excluded by the insurer

N is a student pilot with a large life insurance policy. Which of these features would limit the insurer's obligation in the event N was killed while flying as a student pilot?

exclusion

When an insurer issues a policy that refuses to cover certain risks, this is referred to as a(n)

exclusion

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

file written proof of loss

An insured is past due on his life insurance premium, but is still within the Grace Period. What will the beneficiary receive if the insured dies during this Grace Period?

fully face amount minus any past due premiums

With any insurance policy, what is the purpose of the Grace Period?

gives the policy owner time to pay past due premiums

which of the following provisions specifies how long a policy owner's insurance coverage will remain in effect if the policy owner does not pay the premium when it is due?

grace period

All of these statements about the Waiver of Premium provision are correct EXCEPT

insured must be eligible for social security for claim to be accepted

the agreement in an insurance contract that states a specific sum of money will be paid to a designated person upon an insured's death is called...

insuring agreement

which of the following insurance policy provisions specifies the benefits or services a policy will provide?

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

which of the following statements is correct about accelerated death benefits?

must have a terminal illness to qualify

The Notice of Claims provision requires a policy owner to...

notify an insurer of a claim within a specified time

M had an annual life insurance premium payment due January 1. She died January 10 without making the premium payment. What action will the insurer take?

pay face amount minus the past due premium

the provision that defines to whom the insurer will pay benefits to its called..

payment of claims

which of these statements accurately describes the waiver of the premium provision in an insurance policy?

premiums are waived (or paid) after the insured has been totally disabled for a specific time

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

prevents delayed claim payments paid by the insurer

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?

reinstatement

J let her life insurance policy lapse 8 months ago due to nonpayment. She can reestablish coverage under which of the following provisions?

reinstatement provision

s buys a $10,000 whole life policy in 2003 and pays an annual premium of $100. S dies 5 years later in 2008 and the insurer pays the beneficiary $10,000. What kind of rider did S include on the policy?

return of premium rider

which of the following statements describes the purpose of the insuring clause in an insurance policy?

states the scope and limits of the overage

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

D was actively serving in the Marines when he was killed in an automobile accident while on leave. His $100,000 Whole life policy contains a War Exclusion clause. How much will D's beneficiary's receive?

the full face amount

the consideration clause in an insurance policy indicates that a policy owner's consideration consists of a completed application and...

the initial premium

G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's policy, who is responsible for paying the medical bills?

the insured

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

Which Accident and Health policy provision addresses preexisting conditions?

time limit on certain defenses

if an individual has an accidental death and dismemberment policy and dies, an autopsy can be performed in all these situations except

when the state prohibits this by law