Health Provisions

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?

The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age

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

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

File written proof

The legal actions provision of an insurance contract is designed to do all of the following except

*protect the producer provide insurer adequate time to research protect the insured from having claim research delay give the insured guidelines for legal action against insured

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

20

Insurers may request a hearing within ___ if their policy is rejected

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

M's insurance company denied a reinstatement for her lapsed insurance policy the company did not notify. how many days from the reinstatement application date does the company have to notify m before the policy will be automatically placed back in force

45

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?

Change of occupation provision

P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim?

Claim will be denied

An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?

Consideration clause

"A producer does not have the authority to change a policy or waive any of its provisions". The health provision that best describes this statement is called the

Entire Contract

What is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision

Insured must be under a physician's care

The ___ clause identifies which losses resulting from an accident or sickness are insured by the policy

Insuring

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning

November 1

Which of these statements accurately describes the waiver of premium provision in an accident and health policy

Premiums are waived after the insured has been totally disabled for a specified time period

What is the purpose of the time of payment of claims provision

Prevents delayed claim payments made by the insurer

What must the policyowner provide to the insurer for validation that a loss has occurred?

Proof of Loss

Which Accident and Health policy provision addresses preexisting conditions?

Time Limit on Certain Defenses

Which of the following statements best describes what an accident and health policy owner may NOT do

adjust premium payments

Health insurance benefits NOT covered due to an act of war are

excluded by the insurer in the contract provisions

G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's policy, who is responsible for paying the medical bills?

insured

Which of the following health insured policy provisions specified the heath care services a policy will provide

insuring clause

Periodic health claim payments MUST be made at least

monthly

Which of the following is considered to be the time period after a health policy is issued during which no benefits are provided for illness

probationary period