Life and Health Chapter 12

An insurer has the right to request a physical exam or an autopsy to determine its liability to pay benefits. This request may be made under which provision? A Physical Exam & Autopsy B Intoxicants and Narcotics C Proofs of Loss D Proof of Disability or Death

a

Does the insured have the right to change the beneficiary designation of a health insurance policy? A Yes, unless the beneficiary is designated as irrevocable B No, only the insurer has that right in health policies C No, the beneficiary designation in health policies is always irrevocable D Yes, the beneficiary designation is always revocable in health policies

a

If the insured is receiving regular disability income payments, the insurer can require notice of continuance of claim every ______ months. A 9 B 3 C 6 D 12

c

Once issued, the application becomes part of the ___________, when attached. A Part 1 B Agent's Report C Entire contract D Part 2

c

One of your clients just reinstated his health insurance plan. When is coverage effective for sickness and accident? A 10 days for accident and 48 hours for sickness B 30 days for sickness, immediate coverage for accidents C 10 days for sickness, and immediately for accidental injuries D Immediately for both accident and sickness

c

Louise purchased a disability policy when her salary was $4,000 a month. Later, she lost that job and her salary was reduced to $2,000 a month. Three years ago, she became self-employed and now receives $3,500 a month. The maximum disability benefit she might expect will be based on which salary amount? A $2,000 B $4,000 C The weighted average of her income levels over the life of the contract D $3,500

d

What is an impairment rider? A It excludes specific conditions that normally would cause the entire policy to be declined B It pays out an additional benefit in cases where the cause of loss is a result of an accident C It pays out an additional benefit if the insured cannot perform 2 of the 5 specified functional activities D It guarantees the insured's future insurability

a

Beth has a contract stating she must be disabled for 3 months before benefits will begin to be paid. This 3-month period is known as the: A Probationary Period B Elimination Period C Contingency Period D Grace Period

b

Case managers do all of the following, except: A Requiring a referral or second opinion prior to approving a procedure B Providing the necessary care C Managing the utilization review of a hospital stay D Determining the appropriate course of action for the insured

b

The Insuring Clause under an individual A&H policy would contain all the following, except: A What perils are covered B Premium or rate calculations C The name of the insured and insurer D The length of the policy period

b

The Legal Actions provision preserves the insured's right to bring suit against his/her own insurer, but the insured must wait at least _____ days after filing a proof of loss before pursuing this action. A 90 B 60 C 30 D 45

b

Which of these is a Mandatory Uniform Provision? A Conformity with State Statutes B Legal Actions C Misstatement of Age D Illegal Occupation

b

Albert owns a printing business in which he, at times, prints counterfeit money. One day while processing counterfeit bills, his arm is severely damaged. His insurance will: A Cover the claim because he was injured on equipment normally used for legal purposes B Not cover the claim because this would be covered under Workers' Compensation C Not cover the claim since he was involved in an illegal act at the time of injury D Cover the claim for this injury, but cancel his policy

c

The Guaranteed Renewable Provision states that the policy is: A Renewable with adjustable premiums determined by frequency of claims B Renewable with no increase in premium C Renewable only at the option of the insurer D Renewable with premiums that may be increased for entire classes of insureds

d

Which statement is false? A Changes in an Accident and Health contract may be completed only with the written consent of the insurer B The Guaranteed Insurability Rider may also be referred to as the Future Insurability Option C Fraudulent misstatements made in the application can be used to deny a claim at any time D Mandatory Second Surgical Opinion is when the physician submits claim information prior to treatment, to determine in advance if the procedure is covered

d