Chapter 6 * - EXAM- Health Insurance Policy Provisions (20 cau)

Insurers may request a hearing within ..... if their policy is reject A: 20 days B: 30 days C: 60 days D: 90 days

A: 20 days Insurers may request a hearing within 20 days if their policy is rejected

When does a Probationary Period provision become effective in a health insurance contract? A: At the policy's inception B: 30 days after the policy's inception C: When a claim is submitted D: When a covered loss occurs

A: At the policy's inception The probationary period begins when a policy goes into effect. During this period, no benefits will be paid under the policy

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period? A: Gives the policyowner additional to pay overdue premiums B: Give the policyowner additional time to file a lawsuit C: Gives the policyowner additional time to file a claim D: Gove the policyowner additional time to provide proof of loss

A: Gives the policyowner additional to pay overdue premiums

Periodic health claim payments MUST be made at least A: Monthly B: weekly C: daily D: annualy

A: Monthly

Which of these is considered a mandatory provision? A: Payment of Claims B: Insurance with Other Insurers C: Misstatement of Age D: Change of Occupation

A: Payment of Claims Payment of Claims is considered a mandatory provision and direct where the claim benefits will go. The other are considered optional provision

An assignment of benefits of a Health Policy A: transfers payments to someone other than the policyowner B: is prohibited by state law C: is allowed only on policies dates after 1992 D: transfers rights from the company to the policyholder

A: transfers payments to someone other than the policyowner An assigment of benefits of a Health Policy transfer payments to someone other than policyowner

An insured must notify of a medical within how many days after an accident A: 10 B: 20 C: 30 D: 40

B: 20 Notice of a claim is typically required within 20 days after the occurrence or a commencement of the loss

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? A: Relation of earning to insurance provision B: Change of occupation provision C: Conformity of states provision D: Entire contract provision

B: Change of occupation provision The change of occupation provision allows an insurer to adjust policy benefits and/or rates if the insured has changed to a more hazardous occupation

T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take? A: Allow her to take a tax deduction on unearned premiums B: Increase her policy's coverage amount C: Decrease her policy 's coverage amount D: Nothing

B: Increase her policy's coverage amount Under the Change of Occupation provision in an Accident & Health policy, if the insured notifies the insurance company of a less hazardous occupation, the insurance company may increase the policy's coverage

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? A: Free-look B: Reinstatement C: Grace Period D: Consideration

B: Reinstatement IN this situation, coverage may be restored under the reinstatement provision

The insuring clause A: Specified the additional time given to pay past due premiums B: State the scope and limits of the coverage C: States the amount of premium to be collected D: Prohibits the insured from suing the insurer for at least 60 days after filling a written proof of loss

B: State the scope and limits of the coverage The purpose of the insuring clause is to specify the scope and limits of the coverage provide

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? A: The reinsurer B: The insured C: The insurer D: The Guaranty Association

B: The insured In this situation, the insured is liable for the medical bills

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 A: Insuring B: Time limit on Certain Defenses C: Grace Period D: Free-look

B: Time limit on Certain Defenses The Limit on certain Defenses (Incontestability) provision limits the time during which the insurance company may challenge the validity of an insurance claim on the basic of a misstatement made on the insured's application

Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waiver any of its provisions A: Time limit on certain Defenses B: Reinstatement C: Entire Contract D: Change of Beneficiary

C: Entire Contract

In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments: A: whenever an insured is unable to work B: During the time an insured is confined in a hospital C: Following an accidental injury, but not during sickness D: After an insured has become totally disabled as defined in the policy

D: After an insured has become totally disabled as defined in the policy The waiver of premium provision keeps the coverage in force within premium if the insured has become totally disabled as defined in the policy

After an insured gives notice os loss. what must he/she do if the insurer does not furnish forms? A: File a lawsuit B: Contract the insurer again requesting forms C: Nothing D: File written proof of loss

D: File written proof of loss The insured may file written proof of loss in any form if the insurer does NOT furnish forms after the insured gives notice of loss

What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision? A: Insured must be unemployed B: Insured must be hospitalized C: Insured must demonstrate financial need D: Insured must be under a physician's care

D: Insured must be under a physician's care Under Waiver of Premium, which is a rider that will pay your premium while you are disabled, you must have a doctor certify that you meet the definition of disability as contained in the rider

The provision that defines to whom the insurer will pay benefits to is called A: Entire Contract B: Proof of Loss C: Claim Forms D: Payment of Claims

D: Payment of Claims

Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy? A: Pat due premiums on a lapsed policy are waived and coverage is restored B: The insured is paid a monthly benefit to keep insurance premiums current in the event of total disability C: Premiums are waived after the insured has been unemployed for a specified time period D: Premiums are waived after the insured has been totally disabled for a specified time period

D: Premiums are waived after the insured has been totally disabled for a specified time period The Waiver of Premium provision waives the payment of premiums after the insured has been totally disabled for a specified period of time

With Optionally Renewable Health policies, the insurer may: A: Renew the policy only if no claims have been filed the previous year B: Renew the policy only with the insured's consent C: Renew the policy whenever they please and determine whether or not to renew it D: Review the policy annually and determine weather or not to renew it

D: Review the policy annually and determine weather or not to renew it