CH 9 - Health Insurance Policy Provision, Riders & Exclusions
An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim. 10 15 20 25
15
Kathy pays a monthly premium on her health insurance policy. How long is her grace period? 10 days 7 days 31 days 45 days
A)
Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered Guaranteed Renewable Optionally Renewable Conditionally Renewable Noncancellable
D) Noncancellable
Kathy pays a monthly premium on her health insurance policy. How long is her grace period? 10 days 7 days 31 days 45 days
10 days
Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. 10 20 31 60
20
The legal action provision in a health contract is limited to no more than ___ years. 2 3 4 5
5
A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n) guaranteed renewable policy conditionally renewable policy optionally renewable policy noncancelable policy
A)
Bruce is involved in an accident and becomes totally and permanently disabled. His insurance policy continues in force without payment of further premiums. Which policy provision is responsible for this? Waiver of premium provision Insuring provision Return of premium provision Automatic premium loan provision
A)
David submits a $500 claim for medical expenses. There is a past-due amount owed for insurance premiums of $200. As a result, the insurer only pays $300 for the claim. This deduction came as a result of which provision? Unpaid provision Consideration clause Waiver of premium provision Reduced benefit clause
A)
The insurer has the option of terminating a health insurance policy on a date stated in the contract. What type of policy is this? Optionally renewable Renewable Conditionally renewable Cancellable
A)
The reinstatement provision in a health insurance policy is mandatory optional voluntary discretionary
A)
The time limit for filing claim disputes is addressed in which provision of an accident and health policy? Legal actions Entire contract Time of payment of claims Payment of claims
A)
Which of the following is NOT a common exclusion for a medical expense policy? Physical therapy Act of war On-the-job injury Self inflicted injury
A)
Which of the following is NOT a required uniform provision in individual health policies? Change of occupation Legal Actions Notice of claim Reinstatement
A)
Kathy pays a monthly premium on her health insurance policy. How long is her grace period? 10 days 7 days 31 days 45 days
A) 10 days
The time limit for filing claim disputes is addressed in which provision of an accident and health policy? Legal actions Entire contract Time of payment of claims Payment of claims
A) Legal actions
David submits a $500 claim for medical expenses. There is a past-due amount owed for insurance premiums of $200. As a result, the insurer only pays $300 for the claim. This deduction came as a result of which provision? Unpaid provision Consideration clause Waiver of premium provision Reduced benefit clause
A) Unpaid provision
A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n): guaranteed renewable policy conditionally renewable policy optionally renewable policy noncancelable policy
A) guaranteed renewable policy
The reinstatement provision in a health insurance policy is: mandatory optional voluntary discretionary
A) mandatory
Which of the following is NOT a common exclusion for a medical expense policy? Physical therapy Act of war On-the-job injury Self inflicted injury
A) physical therapy
What amount will be paid under a policy where the insured misstated his/her age? The amount stated in the policy, only if the insured pays an additional premium No adjustments will be made An amount the premium would have purchased at the correct age No amount will be paid because the insured misstated his/her age
An amount the premium would have purchased at the correct age.
A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n) conditionally renewability clause optional renewability clause selective renewability clause cancelable clause
B)
A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called limited renewable conditionally renewable guaranteed renewable conditionally cancelable
B)
An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim. 10 15 20 25
B)
In group health care, what is the purpose of the coordination of benefits provision? Determines where an insured goes to receive treatment Determines what is paid by the primary and secondary insurers in the event of a claim Ensures that a health provider receives the proper benefit amount owed Determines which parent's plan covers a dependent child
B)
This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes the partial insurance contract between the parties the entire insurance contract between the parties the conformity of state statutes the legal purpose of the contract
B)
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? Relation of earnings to insurance provision Change of occupation provision Conformity of state statutes provision Modified occupation provision
B)
Which type of health insurance policy cannot be canceled by the insurer nor increase the premiums? Renewable Noncancellable Guaranteed renewable Conditionally renewable
B)
Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. 10 20 31 60
B)
An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim. 10 15 20 25
B) 15
Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. 10 20 31 60
B) 20
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? Relation of earnings to insurance provision Change of occupation provision Conformity of state statutes provision Modified occupation provision
B) Change of occupation provision
In group health care, what is the purpose of the coordination of benefits provision? Determines where an insured goes to receive treatment Determines what is paid by the primary and secondary insurers in the event of a claim Ensures that a health provider receives the proper benefit amount owed Determines which parent's plan covers a dependent child
B) Determines what is paid by the primary and secondary insurers in the event of a claim
A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called limited renewable conditionally renewable guaranteed renewable conditionally cancelable
B) conditionally renewable
A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n): conditionally renewability clause optional renewability clause selective renewability clause cancelable clause
B) optional renewability clause
This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes: the partial insurance contract between the parties the entire insurance contract between the parties the conformity of state statutes the legal purpose of the contract
B) the entire insurance contract between the parties
A health insurance policy paid on a quarterly basis has a grace period of 7 days 10 days 31 days 60 days
C)
All of the following are functions of an insuring clause EXCEPT States the conditions under which the policy will pay Outlines the kind of benefits provided Primarily describes the free-look period Provides the policy's scope and limits of coverage
C)
All of the following are included as part of a contract in the entire contract provision EXCEPT the riders application changes made by the producer policy
C)
Christine has a health insurance policy that has been in force beyond the incontestable period. The insurer has discovered that a fraudulent statement was made on the application. What would the insurer have to pay on a claim, assuming this wasn't a guaranteed renewable policy? Nothing 50% of the claim's amount 75% of the claim's amount 100% of the claim's amount
C)
Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation? Payment of claims Legal actions Unpaid premium Time of payment of claims
C)
The misstatement of age provision in a health policy states that if an insured gives the wrong age at the time of application, what action can the insurance company take? Reissue the policy Policy cancellation Benefits can be adjusted Premiums can be adjusted
C)
Under a health insurance policy, the provision that states the kind of benefits provided and the circumstances under which they will be paid is called the? payment of claims provision entire contract provision insuring clause benefit clause
C)
Under a noncancellable health insurance policy, an insurer can cancel the policy for any reason change the policy provisions cancel the policy for nonpayment of premium increase the premium
C)
Under the Payment of Claims provision, when are benefits typically payable after proof of loss is received? within 60 days Within 30 days Immediately By the end of the calendar year
C)
What amount will be paid under a policy where the insured misstated his/her age? The amount stated in the policy, only if the insured pays an additional premium No adjustments will be made An amount the premium would have purchased at the correct age No amount will be paid because the insured misstated his/her age
C)
What type of changes can be made to a guaranteed renewable health insurance policy? The policy's provisions The grace period The premium rates of the policyowner The incontestability period
C)
Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? Stop renewing policy when the insured reaches a specified age Cancel policy if premiums are not paid Increase the premiums on an individual basis Increase the premiums on the basis of an entire classification
C)
Which of the following is NOT a required provision in an accident and health insurance policy? legal actions grace period change of occupation reinstatement
C)
What amount will be paid under a policy where the insured misstated his/her age? The amount stated in the policy, only if the insured pays an additional premium No adjustments will be made An amount the premium would have purchased at the correct age No amount will be paid because the insured misstated his/her age
C) An amount the premium would have purchased at the correct age.
All of the following are included as part of a contract in the entire contract provision EXCEPT the: riders application changes made by the producer policy
C) Changes made by the producer
Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? Stop renewing policy when the insured reaches a specified age Cancel policy if premiums are not paid Increase the premiums on an individual basis Increase the premiums on the basis of an entire classification
C) Increase the premiums on an individual basis
A beneficiary change can occur: Only upon the request of the revocable beneficiary Only on specified dates within the policy Normally at any time during the policy term At no time
C) Normally at any time during the policy term
All of the following are functions of an insuring clause EXCEPT: States the conditions under which the policy will pay Outlines the kind of benefits provided Primarily describes the free-look period Provides the policy's scope and limits of coverage
C) Primarily describes the Free-look period
Which of the following is NOT a required provision in an accident and health insurance policy? legal actions grace period change of occupation reinstatement
C) change of occupation
Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation? Payment of claims Legal actions Unpaid premium Time of payment of claims
C) unpaid premium
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? Relation of earnings to insurance provision Change of occupation provision Conformity of state statutes provision Modified occupation provision
Change of occupation provision
All of the following are included as part of a contract in the entire contract provision EXCEPT the: riders application changes made by the producer policy
Changes made by the producer
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss
D)
Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered Guaranteed Renewable Optionally Renewable Conditionally Renewable Noncancellable
D)
In contrast to a guaranteed renewable policy, a noncancellable policy may cancel the policy only at renewal may raise premiums at policy renewal may raise premiums at anytime may never raise premiums
D)
In what situation does a waiver of premium provision keep a health insurance policy in force without premium payments? When an insured becomes unemployed When an insured is involved in an accident at work When an insured is confined in a hospital When an insured becomes totally disabled
D)
In which of the following situations would the insurer be liable for a loss? The insured skipped a payment beyond the 31 day grace period The insured was injured while participating in an illegal occupation The insured was given a notice of cancellation from the insurer The insured suffered an injury as an innocent bystander during a bank robbery
D)
Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be cancelable guaranteed renewable conditionally renewable optionally renewable
D)
States that have "no loss no gain" laws require a replacing policy to keep the same type of coverage as the policy it replaces not charge a different premium from the policy it replaces pay for half of any ongoing claims under the policy it replaces pay for ongoing claims under the policy it replaces
D)
The conditions, times, and circumstances under which an insured is NOT covered by a health policy are called? reinstatements deductibles inclusions exclusions
D)
The entire contract includes the actual policy and the inspection report warranty statements provisions application
D)
The legal action provision in a health contract is limited to no more than ___ years. 2 3 4 5
D)
The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called noncancelable conditionally renewable optionally renewable cancelable
D)
The legal action provision in a health contract is limited to no more than ___ years. 2 3 4 5
D) 5
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss
D) File written proof of loss
In which of the following situations would the insurer be liable for a loss? The insured skipped a payment beyond the 31 day grace period The insured was injured while participating in an illegal occupation The insured was given a notice of cancellation from the insurer The insured suffered an injury as an innocent bystander during a bank robbery
D) The insured suffered an injury as an innocent bystander during a bank robbery
The entire contract includes the actual policy and the inspection report warranty statements provisions application
D) application
The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called noncancelable conditionally renewable optionally renewable cancelable
D) cancelable
In contrast to a guaranteed renewable policy, a noncancellable policy: may cancel the policy only at renewal may raise premiums at policy renewal may raise premiums at anytime may never raise premiums
D) may never raise premiums
Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be: cancelable guaranteed renewable conditionally renewable optionally renewable
D) optionally renewable
States that have "no loss no gain" laws require a replacing policy to: keep the same type of coverage as the policy it replaces not charge a different premium from the policy it replaces pay for half of any ongoing claims under the policy it replaces pay for ongoing claims under the policy it replaces
D) pay for ongoing claims under the policy it replaces
In group health care, what is the purpose of the coordination of benefits provision? Determines where an insured goes to receive treatment Determines what is paid by the primary and secondary insurers in the event of a claim Ensures that a health provider receives the proper benefit amount owed Determines which parent's plan covers a dependent child
Determines what is paid by the primary and secondary insurers in the event of a claim
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss
File written proof of loss
Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? Stop renewing policy when the insured reaches a specified age Cancel policy if premiums are not paid Increase the premiums on an individual basis Increase the premiums on the basis of an entire classification
Increase the premiums on an individual basis
The time limit for filing claim disputes is addressed in which provision of an accident and health policy? Legal actions Entire contract Time of payment of claims Payment of claims
Legal actions
Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered Guaranteed Renewable Optionally Renewable Conditionally Renewable Noncancellable
Noncancellable
All of the following are functions of an insuring clause EXCEPT: States the conditions under which the policy will pay Outlines the kind of benefits provided Primarily describes the free-look period Provides the policy's scope and limits of coverage
Primarily describes the Free-look period
In which of the following situations would the insurer be liable for a loss? The insured skipped a payment beyond the 31 day grace period The insured was injured while participating in an illegal occupation The insured was given a notice of cancellation from the insurer The insured suffered an injury as an innocent bystander during a bank robbery
The insured suffered an injury as an innocent bystander during a bank robbery
Adjust the benefits
Under the misstatement of age provision in a health insurance policy, what can a company do if it discovers that an insured gave a wrong age at the time of application? Cancel the policy Increase the premium Adjust the benefits Assess a penalty
David submits a $500 claim for medical expenses. There is a past-due amount owed for insurance premiums of $200. As a result, the insurer only pays $300 for the claim. This deduction came as a result of which provision? Unpaid provision Consideration clause Waiver of premium provision Reduced benefit clause
Unpaid provision
The entire contract includes the actual policy and the inspection report warranty statements provisions application
application
The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called noncancelable conditionally renewable optionally renewable cancelable
cancelable
Which of the following is NOT a required provision in an accident and health insurance policy? legal actions grace period change of occupation reinstatement
change of occupation
A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called limited renewable conditionally renewable guaranteed renewable conditionally cancelable
conditionally renewable
A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n): guaranteed renewable policy conditionally renewable policy optionally renewable policy noncancelable policy
guaranteed renewable policy
The reinstatement provision in a health insurance policy is: mandatory optional voluntary discretionary
mandatory
In contrast to a guaranteed renewable policy, a noncancellable policy: may cancel the policy only at renewal may raise premiums at policy renewal may raise premiums at anytime may never raise premiums
may never raise premiums
A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n): conditionally renewability clause optional renewability clause selective renewability clause cancelable clause
optional renewability clause
Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be: cancelable guaranteed renewable conditionally renewable optionally renewable
optionally renewable
States that have "no loss no gain" laws require a replacing policy to: keep the same type of coverage as the policy it replaces not charge a different premium from the policy it replaces pay for half of any ongoing claims under the policy it replaces pay for ongoing claims under the policy it replaces
pay for ongoing claims under the policy it replaces
Which of the following is NOT a common exclusion for a medical expense policy? Physical therapy Act of war On-the-job injury Self inflicted injury
physical therapy
This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes: the partial insurance contract between the parties the entire insurance contract between the parties the conformity of state statutes the legal purpose of the contract
the entire insurance contract between the parties
Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation? Payment of claims Legal actions Unpaid premium Time of payment of claims
unpaid premium