Chapter exam- health insurance policy provisions

K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered

Guaranteed renewable

X is insured with a disability income policy that provides coverage until age 65. This policy allows the insurer to change the premium rate for the overall risk class assigned. Which of these renewability features does this policy contain?

Guaranteed renewable

T applied for a Disability Income policy and has a history of back injuries. The insurer issued the policy with a statement that excludes coverage for back injuries. This statement is called a(n)

Impairment Rider

Pre-hospitalization authorization is considered an example of:

managed care

Which type of plan normally includes hospice benefits?

managed care plans

Periodic health claim payments MUST be made at least

monthly

Which of the following BEST describes a short-term medical expense policy?

nonrenewable

The Notice of Claims provision requires a policy owner to

notify an insurer of a claim within a specified time

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 accident and health policy provision addresses preexisting conditions

Time Limit on Certain Defenses

Which of the following BEST describes how pre-admission certification is used

Used to prevent nonessential medical costs

If an individual is covered under an Accidental Death Policy and dies, an autopsy can be performed in all these situations, EXCEPT

When the state prohibits this by law

A(n) _____ of benefits of a health policy transfers payments to someone other than the policyowner

assignment

P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax?

$0

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.

15

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

20

Insurers may request a hearing within ___ if their policy is rejected

20 days

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

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 force even though the premium has not been paid?

31 days

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

T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. How are the $3,000 benefit payments taxable?

Benefits are taxable to T

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

A disability income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim?

Claim will be paid and coverage will remain in force

S is the policyowner of a Major Medical policy. The premiums are paid monthly and due on the 1st of each month. S fails to make September's payment and is hospitalized October 15th. When S files the claim for this hospitalization, the insurer will likely:

Deny the claim

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 of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy

Entire Contract

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning

November 1

The provision that defines to whom the insurer will pay benefits to is called

Payment of Claims

The insured and insurance company will share the cost of covered losses under which health policy feature

Payment of Claims provision

What is considered to be a characteristic of a Conditionally 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

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?

The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age

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

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?

Increase her policy's coverage amount