Health Insurance Policy Provisions (6) end questions

Which Accident and Health policy provision addresses preexisting conditions?

- Time Limit on Certain Defenses

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

-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?

-31

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

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

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?

-Entire Contract

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

-File written proof of loss

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?

-Guaranteed Renewable.

Which health policy clause specifies the amount of benefits to be paid?

-Insuring

What is considered to be a characteristic of a Conditionally Renewabe Health Insurance policy?

-Premiums may increase at time o renewal

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

-Premiums normally increase at time of renewal

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

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?

-Submit the claim in any form

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?

-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:

-Time Limit on Certain Defenses

What type of rider would be added to an Accident and Health policy if the policy owner wants to ensure the policy will continue if he/she ever becomes totally disabled?

-Waiver of Premium rider

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 describes this policy is called

-noncancellable

What is the purpose of the Time of Payment of Claims provision?

-prevent the insurance company from delaying claim payments.

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

C) After an insured has become totally disabled as defined in the policy.

Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy? A) Waiver B) Exceptions and Reductions C) Incontestable D) Entire Contract

D) Entire Contract

What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision? A) Insured must be unemployed B) Insured must be hospitalized C) Insured must demonstrate financial need D) Insured must be under a physician's care

D) Insured must be under a physician's care