Health Insurance Policy Provisions

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss

File written proof of loss

Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered Guaranteed Renewable Optionally Renewable Conditionally Renewable Noncancellable

Noncancellable

All of the following are functions of an insuring clause EXCEPT: States the conditions under which the policy will pay Outlines the kind of benefits provided Primarily describes the free-look period Provides the policy's scope and limits of coverage

Primarily describes the Free-look period

A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n): guaranteed renewable policy conditionally renewable policy optionally renewable policy noncancelable policy

guaranteed renewable policy

The reinstatement provision in a health insurance policy is: mandatory optional voluntary discretionary

mandatory

This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes: the partial insurance contract between the parties the entire insurance contract between the parties the conformity of state statutes the legal purpose of the contract

the entire insurance contract between the parties

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 Modified occupation provision

Change of occupation provision

All of the following are included as part of a contract in the entire contract provision EXCEPT the: riders application changes made by the producer policy

Changes made by the producer

Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. 10 20 31 60

20

Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be: cancelable guaranteed renewable conditionally renewable optionally renewable

optionally renewable

The entire contract includes the actual policy and the inspection report warranty statements provisions application

application

Kathy pays a monthly premium on her health insurance policy. How long is her grace period? 10 days 7 days 31 days 45 days

10 days

An insurer must furnish to a claimant forms for filing proof of loss within ___ days upon receiving a notice of claim. 10 15 20 25

15

The legal action provision in a health contract is limited to no more than ___ years. 2 3 4 5

5

Which of the following is NOT a common exclusion for a medical expense policy? Physical therapy Act of war On-the-job injury Self inflicted injury

physical therapy

In which of the following situations would the insurer be liable for a loss? The insured skipped a payment beyond the 31 day grace period The insured was injured while participating in an illegal occupation The insured was given a notice of cancellation from the insurer The insured suffered an injury as an innocent bystander during a bank robbery

The insured suffered an injury as an innocent bystander during a bank robbery

Which of the following is NOT a required provision in an accident and health insurance policy? legal actions grace period change of occupation reinstatement

change of occupation

A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called limited renewable conditionally renewable guaranteed renewable conditionally cancelable

conditionally renewable

In contrast to a guaranteed renewable policy, a noncancellable policy: may cancel the policy only at renewal may raise premiums at policy renewal may raise premiums at anytime may never raise premiums

may never raise premiums

The time limit for filing claim disputes is addressed in which provision of an accident and health policy? Legal actions Entire contract Time of payment of claims Payment of claims

Legal actions

David submits a $500 claim for medical expenses. There is a past-due amount owed for insurance premiums of $200. As a result, the insurer only pays $300 for the claim. This deduction came as a result of which provision? Unpaid provision Consideration clause Waiver of premium provision Reduced benefit clause

Unpaid provision

Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation? Payment of claims Legal actions Unpaid premium Time of payment of claims

unpaid premium

In group health care, what is the purpose of the coordination of benefits provision? Determines where an insured goes to receive treatment Determines what is paid by the primary and secondary insurers in the event of a claim Ensures that a health provider receives the proper benefit amount owed Determines which parent's plan covers a dependent child

Determines what is paid by the primary and secondary insurers in the event of a claim

Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? Stop renewing policy when the insured reaches a specified age Cancel policy if premiums are not paid Increase the premiums on an individual basis Increase the premiums on the basis of an entire classification

Increase the premiums on an individual basis

The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called noncancelable conditionally renewable optionally renewable cancelable

cancelable

A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n): conditionally renewability clause optional renewability clause selective renewability clause cancelable clause

optional renewability clause

What amount will be paid under a policy where the insured misstated his/her age? The amount stated in the policy, only if the insured pays an additional premium No adjustments will be made An amount the premium would have purchased at the correct age No amount will be paid because the insured misstated his/her age

An amount the premium would have purchased at the correct age.

States that have "no loss no gain" laws require a replacing policy to: keep the same type of coverage as the policy it replaces not charge a different premium from the policy it replaces pay for half of any ongoing claims under the policy it replaces pay for ongoing claims under the policy it replaces

pay for ongoing claims under the policy it replaces