XCEL Chapter 9 - Health Insurance Policy Provisions

Kathy pays a monthly premium on her health insurance policy. How long is her grace period?

10 days

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

15

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

20

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

5

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?

Unpaid premium

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

The entire contract includes the actual policy and the

application

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

cancelable

Which of the following is NOT a required provision in an accident and health insurance policy?

change of occupation

All of the following are included as part of a contract in the entire contract provision EXCEPT the

changes made by the producer

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

conditionally renewable

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

The reinstatement provision in a health insurance policy is

mandatory

In contrast to a guaranteed renewable policy, a noncancellable policy

may never raise premiums

A beneficiary change can occur:

normally at any time during the policy term

A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n)

optional renewability clause

Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be

optionally renewable

States that have "no loss no gain" laws require a replacing policy to

pay for ongoing claims under the policy it replaces

This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes

the entire insurance contract between the parties

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

File written proof of loss

Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit?

Increase the premiums on an individual basis

What amount will be paid under a policy where the insured misstated his/her age?

An amount the premium would have purchased at the correct age

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

In group health care, what is the purpose of the coordination of benefits provision?

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

The time limit for filing claim disputes is addressed in which provision of an accident and health policy?

Legal actions

Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered

Noncancellable

Which of the following is NOT a common exclusion for a medical expense policy?

Physical therapy

All of the following are functions of an insuring clause EXCEPT

Primarily describes the free-look period

In which of the following situations would the insurer be liable for a loss?

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