nm 2 (general)

capital amount

Conrad receives $50,000 from a $100,000 accidental death and dismemberment policy as a result of the loss of his left arm in an accident. Conrad has received the

2 years

according to the time limit on certain defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny a claim after the policy has been in force for a minimum of how many years?

renewability provision

an insured wants to cancel her health insurance policy. which portion of the contract would explain cancellation rights?

A

medicare part A services do NOT include which of the following? A. private duty nursing B. post hospital skilled nursing facility care C. hospitalization D. hospice care

establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in a calendar year

the "stop-loss" feature on a major medical policy is intended to

premium mode

the frequency and the amount of the premium payment are known as what?

subrogation

upon payment of a loss, the insured is obligated to surrender to the insurer the right to sue a negligent third party. this is called

copay

HMO members pay a small fee when they see their primary care physician this fee is called a

insuring clause

Riley reads an agreement on the first page of her policy with includes a list of losses that will be covered by her insurer. what is the name of this agreement?

the insured can select any specialist, but non-network specialists will have higher out-of-pocket costs

an insured is anxious to get treatment for a health condition, and is convinced that a specialist is needed to cure the condition. if the insured has a PPO plan, which is true?

a specified period of time that a person joining a group has to wait before becoming eligible for coverage

the probationary period is

entire contract provision

the uniform provision law that prevents an insurance company from altering its agreement with a policyholder by referring to documents or other items not contained in the policy is called the

A

to be valid, an insurance policy must have all of the following EXCEPT A. countersignature B. acceptance C. consideration D. offer

60 days after written proof of loss has been submitted

under the mandatory uniform provision legal actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to

a warranty

what guarantees that the information explained in the insurance contract is true?

it becomes part of the entire contract

what happens to the copy of the application for health insurance once the policy is issued?

to exclude coverage for a specific impairment

what is the purpose of the impairment rider in a health insurance policy?

basic surgical expense insurance

what specific kind of insurance is often written in conjunction with hospital expense policies and includes surgeons' and anesthsiologists' fees?

immediately

when an insured reinstated his major medical policy, he was involved in an accident that required hospitalization. when would this accident be covered upon reinstatement of the policy?

A

which of the following is NOT mandatory under the uniform provisions law as applied to accident and health policies? A. change of occupation B. time limit on certain defenses C. physical examination and autopsy D. entire contract

key person disability income

if a business wants to make sure it will be able to cover losses due to the disability of its top employee, the business should get which type of insurance?

the underwriters approve the application

if an applicant submit the initial premium with an application, which action constitutes acceptance?

the mode of premium payment

in health insurance, the length of the grace period varies according to

a percentage of the cost of service that the insured and the insurer share

in health insurance, what is coinsurance

B

which of the following is NOT normally an excluded cause of disability in an individual disability income policy? A. war B. complication from pregnancy C. injury resulting from illegal activity D. suicide

C

which of the following is NOT true regarding a noncancellable policy? A. the guarantee to renew coverage usually only applies until the insured reached age 65 B. insured has the unilateral right to renew the policy for the life of the contract, and many discontinue paying premiums to cancel it C. insurer can increase the premium above what is stated in the policy if claims experience is greater than expected D. insurer cannot cancel the policy

the agent's

whose responsibility is it to ensure that the application for health insurance is complete and accurate?

A

an insured was seriously injured in a skiing accident that required him to be hospitalized for 5 weeks. his medical expense policy covered all of the following EXCEPT A. loss of income while hospitalized B. necessary medicine and medical supplies C. surgerical expense D. hospital room and board

one that is severe enough that the insured automatically qualifies for full disability benefits

describe a presumption disability

a specified period of time that a person joining a group has to wait before becoming eligible for coverage

defines the probationary period in group health policies

it provides catastrophic medical coverage beyond basic benefits on a usual, customary and reasonable basis

describes a major medical expense policy

C

medicare is a health insurance program for all the following individuals EXCEPT A. those with permanent kidney failure B. those who have been on social security disability for 2 years C. those with low income and low assets D. those 65 or over

principal sum

on an accidental death and dismemberment policy, the death benefit payable is known as the