Chapter Exam - Health Provisions

What type of renewability guarantees premium rates and renewability?

Optionally renewable Conditionally Renewable Noncancellable Warranties renewable

What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision

Insured must be unemployed Insured must be hospitalized Insured must demonstrate financial need Insured must be under a physician's care

Periodic health claim payments MUST be made at least

Monthly Weekly Daily Annually

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

Excluded by the insurer in the contract provisions Assigned to a reinsurer Given a longer probationary period Charged a higher premium

What should an insured do if the insurer does not send claim forms within the time period set forth in a health policy's Claims Forms provision

File a lawsuit Submit the claim in any form Wait for the claim form to arrive Resubmit the request for a claim form

Which of the following is NOT included in the policy face?

Free Look provision Name of the insured Name of the insurer Exclusions

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 Within 6 months At the insurer's discretion Within 3 months

Which Accident and Health policy provision addresses preexisting conditions?

Proof of loss Legal actions Time limit on certain defenses Payment of claims

The Legal Actions provision of an insurance contract is designed to do all of the following, EXCEPT:

Provide the insurer adequate time to research a claim Protect the insured from having claim research delayed Protect the producer Give the insured guidelines for pursuing legal action against the insurer

The insuring clause

Specifies the additional time given to pay past due premiums States the scope and limits of coverage States the amount of premium to be collected Prohibits the insured from suing the insurer for at least 60 days after filing a written proof of loss

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

5 10 15 20

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?

7 10 20 31

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?

Allow her to take a tax deduction on unearned premiums Increase her policy's coverage amount Decrease her policy's coverage amount Nothing

Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires?

An insured must settle a claim within 60 days after a loss is submitted An insured must wait at least 30 days after proof of loss has been submitted before a lawsuit can be filed An insured must wait at least 60 days after proof of loss has been submitted before a lawsuit can be filed An insured must settle a claim within 30 days after proof of loss is submitted

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

Conditionally Renewable Noncancellable Guaranteed renewable Nonrenewable

An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?

Entire Contract clause MIB clause Insuring clause Consideration clause

Which of these statements accurately describes the Waiver of Premiums provision in an Accident and Health policy?

Past due premiums on a lapsed policy are waived and coverage is restored The insured is paid a monthly benefit to keep insurance premiums current in the event of total disability Premiums are waived after the insured has been unemployed for a specified time period Premiums are waived after the insured has been totally disable for a specified period of time

Which of these is considered a mandatory provision?

Payment of claims Insurance with other Insurers Misstatement of age Change of occupation

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

Premiums normally decrease at the time of renewal Premiums normally increase at the time of renewal Policy can be renewed at any time by the company Policy can be cancelled at any time by the company

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

Waiver Exceptions and Reductions Incontestable Entire Contract