Health Insurance Policy Premiums

Which of the following health insurance policy provisions specifies the health care services a policy will provide? Insuring clause Usual, Customary, and Reasonable clause Consideration clause Benefit clause

insuring clause

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options? Annually Semiannually Quarterly Monthly

monthly

Periodic health claim payments MUST be made at least monthly weekly daily annually

monthly

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called noncancellable conditionally renewable cancellable guaranteed renewable

noncancellable

J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase? Guaranteed Renewable Noncancelable Optionally Renewable Conditionally Renewable

noncancellable

What type of renewability guarantees premium rates and renewability? Optionally renewable Conditonally renewable Noncancellable Guaranteed renewable

noncancellable

Which of the following BEST describes a short-term medical expense policy? Conditionally renewable Noncancellable Guaranteed renewable Nonrenewable

nonrenewable

The Notice of Claims provision requires a policyowner to -provide proof of loss to an insurer within a specified time -notify an insurer of a claim within a specified time -wait 60 days after filing a claim to initiate a lawsuit against an insurer -notify their physician of a claim within a specified time

notify an insurer of a claim within a specified time

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 September 21 October 16 November 1 December 1

november 1 (must wait 60 days before taking legal action)

The provision that defines to whom the insurer will pay benefits to is called Entire Contract Proof of Loss Claim Forms Payment of Claims

payment of claims

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the Insuring clause Contestable clause Consideration clause Free-look provision

insuring clause

Which of these is considered a mandatory provision? Payment of Claims Insurance with Other Insurers Misstatement of Age Change of Occupation

payment of claims

Which of these statements accurately describes the Waiver of Premium 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 disabled for a specified time period

premiums are waived after the insured has been totally disabled for a specified time period

Which of the following statements describes what an Accident and Health policyowner may NOT do? File a covered claim Assign ownership Cancel the coverage Adjust the premium payments

adjust the premium payments

In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments Whenever an insured is unable to work During the time an insured is confined in a hospital Following an accidental injury, but not during sickness After an insured has become totally disabled as defined in the policy

after an insured has become totally disabled as defined in the policy

When does a Probationary Period provision become effective in a health insurance contract? At the policy's inception 30 days after the policy's inception When a claim is submitted When a covered loss occurs

at the policy's inception

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss. 5 10 15 20

15

An insured must notify an insurer of a medical claim within how many days after an accident? 10 20 30 40

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

31

According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid? 7 days 10 days 31 days 60 days

31 days

M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force? 10 days 30 days 45 days 60 days

45 days

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? Consideration Entire Contract Free-look Insuring

entire contract

Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions? Time Limit on Certain Defenses Reinstatement Entire Contract Change of Beneficiary

entire contract

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

entire contract

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

excluded by the insurer in the contract provisions

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 optionally renewable conditionally renewable guaranteed renewable noncancellable

guaranteed renewable

Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class? Conditionally Renewable Noncancellable Guaranteed Renewable Optionally Renewable

guaranteed renewable

What is the purpose of the Time of Payment of Claims provision? Requires the insured to wait 60 days after submitting Proof of Loss before filing a lawsuit Prevents delayed claim payments made by the insurer Requires a probation period for each claim filed by the insured Protects the insurer from frivolous lawsuits

prevents delayed claim payments made by the insurer

What must the policyowner provide to the insurer for validation that a loss has occurred? Proof of Coverage Proof of Claim Proof of Loss Proof of Payment

proof of loss

G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's policy, who is responsible for paying the medical bills? The reinsurer The insured The insurer The Guaranty Association

the insured

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called Insuring Time Limit on Certain Defenses Grace Period Free-look

time limit on certain defenses

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is Grace Period Physical Examination and Autopsy Entire Contract Time Limit on Certain Defenses

time limit on certain defenses

Which Accident and Health policy provision addresses preexisting conditions? Proof of Loss Legal Actions Time Limit on Certain Defenses Payment of Claims

time limit on certain defenses

An assignment of benefits of a Health Policy transfers payments to someone other than the policyowner is prohibited by state law is allowed only on policies dates after 1992 transfers rights from the company to the policyholder

transfers payments to someone other than the policyowner

According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, nonfraudulent misstatements first become incontestable two years from the date of the policy was issued two years after collection of the initial premium two years from the date of the first claim two years from the date the policies was delivered

two years from the date the policy was issued

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 Proof of 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

an insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? Relation of earnings to insurance provision Change of occupation provision Conformity of state statutes provision Entire contract provisions

change in occupation provision

P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim? Claim will be denied and policy terminated Claim will be partially paid Claim will be paid Claim will be denied

claim will be denied

A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim? Claim will be paid and coverage will remain in force Claim will be denied and coverage will remain in force Claim will be denied and coverage will be cancelled Claim will be denied, the coverage cancelled, and all premiums paid will be refunded

claim will be paid and coverage will remain in force

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

consideration clause

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 Insuring clause Time Limit on Certain Defense provision Legal Contract clause

entire contract provision

The sections of an insurance contract which limit coverage are called waivers riders exclusions limitations

exclusions

Which of the following is NOT included in the policy face? Free Look provision Name of the insured Name of the insurer Exclusions

exclusions

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss

file written proof of loss

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period? Gives the policyowner additional time to pay overdue premiums Gives the policyowner additional time to file a lawsuit Gives the policyowner additional time to file a claim Gives the policyowner additional time to provide proof of loss

gives the policyowner additional time to pay overdue premiums

Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due? Grace Period Consideration Waiver of Premium Reinstatement

grace period

An insurer receives proof of loss for an acceptable medical expense claim under an Individual Health Insurance Policy. Under the Time of Payment of Claims provision, the insurer MUST pay the benefits immediately within a maximum of three months within a reasonable amount of time at least monthly

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

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

insured must be under a physician's care

An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the medical examination is given producer completes the application insurer dates the policy the first premium is paid

insurer dates the policy

Which health policy clause specifies the amount of benefits to be paid? Insuring Consideration Free-look Payment mode

insuring

The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the Entire Contract provision Consideration clause Benefit clause Insuring clause

insuring clause

What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy? Premiums may increase at time of renewal Premiums may increase at any time Policy may be renewed at the discretion of the insured Policy may be amended by insurer at any time

premiums may increase at time of renewal

Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT? Premiums normally decrease at time of renewal Premiums normally increase at time of renewal Policy can renewed at any time by the company Policy can be cancelled at any time by the company

premiums normally increase at time of renewal

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 and insurer

protect the producer

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? Free-look Reinstatement Grace Period Consideration

reinstatement

With Optionally Renewable Health policies, the insurer may -renew the policy only if no claims have been filed the previous year -renew the policy only with the insured's consent -review the policy whenever they please and determine whether or not to renew it -review the policy annually and determine whether or not to renew it

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

The insuring clause Specifies the additional time given to pay past due premiums States the scope and limits of the 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

states the scope and limits of the coverage

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

submit the claim in any form

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take? -The insurer will pay the original benefit stated in the policy -The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age -The insurer will pay the original face amount minus any premium deficiencies owed -The insurer will deny the claim and refund premiums paid

the insured will adjust the benefit to what the premiums paid would have purchased at the insured's actual age

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled? Accidental Death and Dismemberment rider Disability Income rider Guaranteed Insurability rider Waiver of Premium rider

waiver of premium rider

If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations EXCEPT When the cause of death is unknown When the state prohibits this by law When consent for the autopsy is not obtained When foul play was a contributing factor

when the state prohibits this by law