Health policy provisions, clauses, and riders

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policy owner?

Payment of claims unless they need to be paid to the beneficiary.

An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would not be a reason for the insurance company to cancel the policy?

The insured is in an accident and incurs a large claim.

When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees

To renew the policy until the insured has reached 65. The insurer can increase the policy premium on the policy anniversary date.

How soon following the occurrence of a covered loss must an insured submit written proof such as loss to the insurance company?

Within 90 days or as soon as reasonably possible, but not exceed 1 year. Unless not legally competent to comply with this provision.

An insured has endured multiple surgeries and hospitalizations for an illness during the summer months. Her insurer no longer bills her medical expenses. What term best describes the condition she has met?

Stop-Loss limit is a specified dollar amount beyond which the insured no longer participates in the sharing of expenses.

While a claim is pending, an insurance company may require?

An independent examination as often as reasonably

Which of the following is NOT a feature of a guaranteed renewable provisions?

The Insurer can increase the policy premium on a individual basis. Guaranteed renewable provision has all the same features that the noncancellable provision does, with the exception that the insurer can increase the policy premium on the policy anniversary date. However, the premium can only be increased on a class basis, not on individual policy.

The expense for an autopsy covered under the physical exam and autopsy provision is paid by?

The Insurer.

Which of the following entities has the authority to make changes to an insurance policy?

Insurer's executive officer. Only an executive officer of the company not an agent, has authority to make any changes to the policy. The insurer must have the insured's written agreement to the change.

A guaranteed renewable health insurance policy allows the?

policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. Coverage is guaranteed but rates can be adjusted for the entire class.

An insured submitted a notice of claim to the insurer, but never received claim forms, he later submits proof of loss, and explains the nature and extent of loss in a handwritten letter to the insurer. Which of the following would be true?

The insured was in compliance with the policy requirements regarding claims. If the claims forms are not furnished to the insured, the claimant is deemed to have complied with the requirements of the policy if he or she submits written proof of the occurrence, nature of the loss, and extent of loss to the insurer.

Which of the following is true regarding elimination periods and the cost of coverage?

The longer the elimination period, the lower the cost of coverage. The elimination period is a period of days which must expire after the onset of an illness or occurrence of an accident before benefits will be payable.

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 this policy is written with a 30-day?

Elimination period, the elimination period is the time immediately following the start of a disability when benefits are not payable. This is used to reduce the cost of providing coverage and eliminating the f of many claims.

Items stipulated in the contract that the insurer will not provide coverage for are found in the?

Exclusions.