Final: 11

A health insurance policy paid on a quarterly basis has a grace period of

31 days

The legal action provision in a health contract is limited to no more than ___ years.

5

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

File written proof of loss

The time limit for filing claim disputes is addressed in which provision of an accident and health policy?

Legal actions

In which of the following situations would the insurer be liable for a loss?

The insured suffered an injury as an innocent bystander during a bank robbery

The entire contract includes the actual policy and the

application

The conditions, times, and circumstances under which an insured is NOT covered by a health policy are called?

exclusions

A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n)

guaranteed renewable policy

Which of the following is NOT a required uniform provision in individual health policies?

Change of occupation

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

Under a noncancellable health insurance policy, an insurer can

cancel the policy for nonpayment of premium

The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called

cancelable

Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss.

20

In group health care, what is the purpose of the coordination of benefits provision?

Determines what is paid by the primary and secondary insurers in the event of a claim

States that have "no loss no gain" laws require a replacing policy to

pay for ongoing claims under the policy it replaces

In what situation does a waiver of premium provision keep a health insurance policy in force without premium payments?

When an insured becomes totally disabled

The reinstatement provision in a health insurance policy is

mandatory

Which of the following is NOT a required provision in an accident and health insurance policy?

change of occupation

This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes

the entire insurance contract between the parties

Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit?

Increase the premiums on an individual basis

An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim.

15

Which type of health insurance policy cannot be canceled by the insurer nor increase the premiums?

Noncancellable

Which of the following is NOT a common exclusion for a medical expense policy?

Physical therapy

What type of changes can be made to a guaranteed renewable health insurance policy?

The premium rates of the policyowner

Kathy pays a monthly premium on her health insurance policy. How long is her grace period?

10 days

What amount will be paid under a policy where the insured misstated his/her age?

An amount the premium would have purchased at the correct age

The misstatement of age provision in a health policy states that if an insured gives the wrong age at the time of application, what action can the insurance company take?

Benefits can be adjusted

The insurer has the option of terminating a health insurance policy on a date stated in the contract. What type of policy is this?

Optionally renewable

All of the following are included as part of a contract in the entire contract provision EXCEPT the

changes made by the producer

A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called

conditionally renewable

Under a health insurance policy, the provision that states the kind of benefits provided and the circumstances under which they will be paid is called the?

insuring clause

In contrast to a guaranteed renewable policy, a noncancellable policy

may never raise premiums

A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n)

optional renewability clause

Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be

optionally renewable

All of the following are functions of an insuring clause EXCEPT

Primarily describes the free-look period

Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation?

Unpaid premium

David submits a $500 claim for medical expenses. There is a past-due amount owed for insurance premiums of $200. As a result, the insurer only pays $300 for the claim. This deduction came as a result of which provision?

Unpaid provision

Bruce is involved in an accident and becomes totally and permanently disabled. His insurance policy continues in force without payment of further premiums. Which policy provision is responsible for this?

Waiver of premium provision

Under the Payment of Claims provision, when are benefits typically payable after proof of loss is received?

Immediately

Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered

Noncancellable