Chapter 6: lesson4 health provisions

An assignment of benefits of a health policy

transfers payments to someone other than the policyowner

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

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

J Purchased a disability income policy that only J can terminate and on which the rates will never increase above those illustrated in the policy. Which types of policy did J purchase?

Non-cancelable

Which of these statements accurately describe the waiver of premium provision in an accident and health policy?

Premiums are wavered after the insured has been totally disabled for a specified time period

What is considered to be a characteristic of a conditional renewable health insurance policy?

Premiums may increase at time of renewal

Which of the following statements about a guaranteed renewable health insurance policy is correct?

Premiums normally increase at time of renewal

The insuring clause is

States the scope and limits of the coverage...general statement that identifies the basic agreement between the insurance company and the insured, usually located on the first page of the policy.

The policy provision that entities the insurer to establish conditions the insured must meet while A claim is pending is

Time limit on certain Defenses

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 claims validity. The provision that limits the time period during which the company made dispute the claims Validity is called

Time limit on certain defenses

Which accident and health policy provisions addresses pre-existing conditions?

Time limit on certain defenses

What type of writer would be added to an accident and health policy if the policy owner wants to ensure the policy will continue if he ever becomes totally disabled?

Waiver of premium rider

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

excluded by the insurer in the contract provisions

Periodic health claim payments MUST be made at least

monthly

What is considered a mandatory provision?

Payment of claims

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

(At the policy's inception)When policy goes into effect during Probation period No benefits will be paid under the policy

According to the mandatory uniform policy provisions, what is the maximum amount of time after the premium due date during which the policy remains in Forest even though the premium has not been paid?

31 days

And ensure received proof of loss for acceptable medical expense claim under an individual health insurance policy. Under the time of payment of claims provision, the insurer must pay the benefits

Immediately

T Owns an accident and health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under they change the occupation provision, which Actions may her insurance company take?

Increase her policies coverage amount

What is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision?

Insured must be under a physician's care

The clause in an accident and health policy which defines the benefit amounts the insurer will pay is called the

Insuring clause