Health Insurance Policy Provisions Ch. 6

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

T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take?

Increase her policy's coverage amount

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

J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase?

Noncancelable

Which of the following BEST describes a short-term medical expense policy?

Nonrenewable

With Optionally Renewable Health policies, the insurer may

review the policy annually and determine whether or not to renew it

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

Waiver of Premium rider

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

excluded by the insurer in the contract provisions

M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this detail. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?

45 days

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period?

Gives the policy owner additional time to pay overdue premiums

Which of the following provisions specifies how long a policy owner's health coverage will remain in effect if the policy owner does not pay the premium when it is due?

Grace Period

The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the

Insuring clause

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

Insuring clause

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 provision that defines to whom the insurer will pay benefits to is called

Payment of Claims

Which Accident and Health policy provision addresses preexisting conditions?

Time Limit on Certain Defenses

K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered

guarantee renewable

K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the either class of insureds. This type of policy is considered

guaranteed renewable

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

According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, nonfraudulent misstatements first become incontestable

two years from the date of the policy was issued

Which of the following statements describes what an Accident and Health policy owner may NOT do?

Adjust the premium payments

Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires?

An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed

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

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

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?

Entire contract

Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions?

Entire contract

Which of the following is NOT included in the policy face?

Exclusions

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

Insuring

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

Premiums normally increase at time of renewal

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

The Legal Actions provision of an insurance contract is designed to do all of the following EXCEPT

protect the producer

The insuring clause

states the scope and limits of the coverage