Health Policy Provisions, Clauses, and Riders (Quiz)

All of the following are correct about the required provisions of a health insurance policy EXCEPT

A reinstated policy provides immediate coverage for an illness

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

A statement that is sufficiency clear rot identify the insured and the nature of the claim

When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should

Adjust the benefit in accordance with the decreased risk

What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?

As long as the policy is in force

A man in injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

Claim is denied if his policy contains the Illegal Occupation provision

What is the main difference between coinsurance and copayments?

Copayment is a set dollar amount

A waiver of premium provision may be included with which kind of health insurance policy

Disability income

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day

Elimination period

Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether to keep it or not?

Free Look period

Which of the following riders would NOT increase the premium for a policyowner?

Impairment Rider

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause

Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss?

Notice of Claim

An insured pays her Major Medical Insurance premium annually on March 1st. Last March she forgot to mail her premium to the company. On March 19th, she had an accident and broke her leg. The insurance company would

Pay the claim

A guaranteed renewable health insurance policy allows the

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class

In respect to the consideration clause, which of the following is consideration on the part of the insurer?

Promising to pay in accordance with the contract terms

Insurers may change which of the following on a guaranteed renewable health insurance policy?

Rates by class

An insured has endured multiple surgeries and hospitalizations for an illness during the summer months. Her insurer no longer bills her for medical expenses. What term best describes the condition she has met?

Stop-loss limit

Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?

Stop-loss limit

Which of the following is NOT a feature of a noncancellable policy?

The insurer may terminate the contract only at renewal for certain conditions

An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?

Time of Payment of Claims

When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees

To renew the policy until the insured has reached age 65

According to the rights of the renewability rider for cancellable policies, all of the following are correct about the cancellation of an individial insurance policy EXCEPT

Unearned premiums are retained by the insurance company

Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?

Unlimited

A medical expense policy that established the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as

Usual, customary, and reasonable

Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes

Waiver of Premium Rider