Chapter Exam - Health provisions

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.

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

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

at the policy's inception

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

a disability income policy that only the policy owner can terminate and which the rates will never go up is considered to be

noncanceable

What must the policyowner provide to the insurer for validation that a loss has occurred?

proof of loss

With Optionally Renewable Health policies, the insurer may

review the policy annually and determine whether or not to renew it

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

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

15

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

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

health insurance benefits NOT covered due to an act of war are:

excluded by the insurer in the contract provisions

The sections of an insurance contract which limit coverage are called

exclusions

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 sends proof of loss to her insurer for an acceptable medical expense claim under her individual Health Insurance policy. Upon receipt, the insurer must pay the benefits

immediately

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

the limit on certain defenses

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

the __ clause identifies which losses resulting from an accident or sickness are insured by the policy

insuring