8: Health Insurance Provisions

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

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

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

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 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

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 of occupation provision

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

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

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

Noncancelable

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

Nonrenewable

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

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

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

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

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 insure

protect the producer

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

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 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

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

exclusions

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

insuring

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

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