Chapter Exam - Health Provisions

The Legal Actions provision of an insurance contract is designed to do all of the following, Except:

Protect the producer (The Legal Actions provision is designed to do all these EXCEPT protect the producer.)

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?

The insured (In this situation, the insured is liable for the medical bills.)

Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy?

Entire Contract ( An Entire Contract policy provision prohibits an insurance company from incorporating external documents into an insurance policy. )

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

Excluded by the insurer in the contract provisions ( An exclusion is a provision that entirely eliminates coverage for a specified risk, such as an act of war and aviation )

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 ( Under the Time of Payment of Claims provision, the insurer must pay the benefits immediately after receiving proof of loss )

An insured pay premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

31 ( The grace period is a minimum of 31 days for policies that are paid for on an annual basis)

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 ( The change of occupation provision allows an insurer to adjust policy benefits and/or rates f the insured has changed to a more hazardous occupation )

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 ( If a person is injured while committing an illegal act, health insurance will not cover the expense of the injury )

Which health policy clause specifies the amount of benefits to be paid?

Insuring ( In an accident & health policy, the insuring clause states the amount of benefits to be paid )

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the:

Insuring clause ( The insuring clause states the amount of benefits to be paid in an Accident and Health policy )

Which of the following health insurance policy provisions specifics the health care services policy will provide?

Insuring clause (The insuring clause identifies the specific type of health care services that are covered by that policy)

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?

Monthly ( The time of payment for claims is usually specified in different policies as 60 days, 45 days, or 30 days. However, if the claim involves disability income benefits, the benefits must be paid not less frequently than monthly.

What type of renewability guarantees premium rates and renewability?

Noncancellable (Non-cancellable policies provides guaranteed renewability and premium rates)

S filed a written Proof and 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 ( The insured must wait 60 days after written proof of loss before legal action can be brought against the company )

Which of these is considered a mandatory provision?

Payment of claims ( payment of claims is considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions )

Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT?

Premiums normally increase at time of renewal ( A Guaranteed Renewable Health Insurance policy can have increasing premiums at time of renewal )

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is:

Time Limit on Certain Defenses ( The provision limits the period during which an insurer can deny a claim based on a misstatement made by the insured )

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?

Waiver of premium rider ( If a policy owner covered under an accident and health policy wanted to ensure the policy will continue if they ever become totally disabled, they would want to add a waiver of premium rider )

If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations, EXCEPT:

When the state prohibits this by law ( When the state prohibits this by law )

The Notice of Claims provision requires a policy owner to:

notify an insurer of a claim within a specified time (The Notice of Claims Provision spells out the insured's duty to provide the insurer with reasonable notice in the event of a loss.)