Health: Policy Provisions, Clauses, and Riders (2:3)

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day A. Elimination period. B. Blackout period. C. Probationary period. D. Waiver of benefits period.

A. Elimination period.

Which of the following riders would NOT increase the premium for a policyowner? A. Impairment rider B. Payor benefit rider C. Waiver of premium rider D. Multiple indemnity rider

A. Impairment rider

A guaranteed renewable health insurance policy allows the A. Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. B. Policyholder to renew the policy to a stated age and guarantees the premium for the same period. C. Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term. D. Insurer to renew the policy to a specified age.

A. Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

Which of the following is NOT a feature of a guaranteed renewable provision? A. The insurer can increase the policy premium on an individual basis. B. The insured has a unilateral right to renew the policy for the life of the contract. C. Coverage is not renewable beyond the insured's age 65. D. The insured's benefits cannot be reduced.

A. The insurer can increase the policy premium on an individual basis.

Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray? A. 90/10 B. 50/50 C. 75/25 D. 80/20

B. 50/50

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within A. 60 days of a loss. B. 90 days of a loss. C. 20 days of a loss. D. 30 days of a loss.

B. 90 days of a loss.

Which of the following does the Insuring Clause NOT specify? A. The name of the insured B. A list of available doctors C. Covered perils D. The insurance company

B. A list of available doctors

In an optionally renewable policy, the insurer has which of the following options? A. Shorten the notice that the insured receives B. Increase premiums C. Increase the grace period D. Alter the due date so the policy can be cancelled sooner

B. Increase premiums

A guaranteed renewable disability insurance policy A. Is renewable at the option of the insurer to a specified age of the insured. B. Is guaranteed to have a level premium for the life of the policy. C. Cannot be cancelled by the insured before age 65. D. Is renewable at the insured's option to a specified age.

D. Is renewable at the insured's option to a specified age.

Insurers may change which of the following on a guaranteed renewable health insurance policy? A. Coverage B. Individual rates C. No changes are permitted. D. Rates by class

D. Rates by class

An insurance agent proposed an individual health insurance policy that is guaranteed renewable. If the applicant accepts this policy, the insurer agrees that A. The company will change the premium rate based upon the insured's health only. B. The premium rate cannot be changed for any reason. C. The insured will always be able to pay the premiums. D. The company will continue to renew the policy until the insured has reached age 65.

D. The company will continue to renew the policy until the insured has reached age 65.

Which of the following statements is true regarding coinsurance? A. The larger the percentage that is paid by the insured, the higher the required premium will be. B. The smaller the percentage that is paid by the insured, the lower the required premium will be. C. The smaller the percentage that is paid by the insured, the more consistent the required premium will be. D. The larger the percentage that is paid by the insured, the lower the required premium will be.

D. The larger the percentage that is paid by the insured, the lower the required premium will be.

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company? A. As soon as possible B. Within 20 days C. Within 60 days D. Within 90 days or as soon as reasonably possible, but not to exceed 1 year

D. Within 90 days or as soon as reasonably possible, but not to exceed 1 year

According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT A. Unearned premiums are retained by the insurance company. B. The insurer must provide the insured a written notice of the cancellation. C. Claims incurred before cancellation must be honored. D. An insurance company may cancel the policy at any time.

A. Unearned premiums are retained by the insurance company.

Which of the following statements is most correct concerning the changing of an irrevocable beneficiary? A. They may be changed only on the anniversary date of the policy. B. They can be changed only with the written consent of that beneficiary. C. They may be changed at any time. D. They can never be changed.

B. They can be changed only with the written consent of that beneficiary.

Which of the following does the Insuring Clause NOT specify? A. The insurance company B. The name of the insured C. A list of available doctors D. Covered perils

C. A list of available doctors - The Insuring Clause lists the insured, the insurance company, what kind of losses are covered, and for how much the losses would be compensated.

While a claim is pending, an insurance company may require A. The insured to be examined only once annually. B. An independent examination only once every 45 days. C. An independent examination as often as reasonably required. D. The insured to be examined only within the first 30 days.

C. An independent examination as often as reasonably required.

In a group health policy, a probationary period is intended for people who A. Have additional coverage through a spouse. B. Want lower premiums. C. Join the group after the effective date. D. Have a pre-existing condition at the time they join the group.

C. Join the group after the effective date.

In respect to the consideration clause, which of the following is consideration on the part of the insurer? A. Offering an unconditional contract B. Explaining policy revisions to the applicant C. Promising to pay in accordance with the contract terms D. Offering a secondary policy to the applicant

C. Promising to pay in accordance with the contract terms

Which of the following is NOT a feature of a noncancellable policy? A. The guarantee to renew coverage usually applies until the insured reaches certain age. B. The insured has the right to renew the policy for the life of the contract. C. The insurer may terminate the contract only at renewal for certain conditions D. The premiums cannot be increased beyond the amount stated in the policy.

C. The insurer may terminate the contract only at renewal for certain conditions

Which of the following is NOT a feature of a noncancellable policy? A. The guarantee to renew coverage usually applies until the insured reaches certain age. B. The insured has the right to renew the policy for the life of the contract. C. The insurer may terminate the contract only at renewal for certain conditions. D. The premiums cannot be increased beyond the amount stated in the policy.

C. The insurer may terminate the contract only at renewal for certain conditions.