Modules 6 - Health Insurance Policy Provisions

The Waiver of Premium provision in an Accident and Health policy waives the premiums when?

[] After the insured has been totally disabled for a specified time period

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

[] At the policy's inception *Begins when a policy goes into affect. During this period, no benefits will be paid under the policy.

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

Which policy provision prohibits an insurance company from incorporating external documents into an insurance policy?

[] Entire Contract

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

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

[] File written proof of loss

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

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

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

[] Insured must be under a physician's care

Periodic health claim payments MUST be made at least

[] Monthly *under an individual health policy

What type of renewability guarantees premium rates and renewability?

[] Noncancellable

A Disability Income policy that only the policy owner can terminate and which the rates will never increase is considered to be

[] Noncancellable policy

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 insured must wait 60 days after written proof of loss before legal action can be brought against the company.

C is the policyowner of a Comprehensive individual Major Medical policy. C pays an annual premium which is due September 1. If C forgets to pay the premium and is hospitalized September 10, how will the insurer handle this claim?

[] Pay the claim in full minus the premium due *The grace period is 31 days for individual Accident and Health policies that are paid annually

Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT

[] Premiums can normally increase at time of renewal

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

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

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?

[] Reinstatement

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

[] protect the producer

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 days

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

[] 20 days