CH 6 Health Insurance Policy and Provisions

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?

Reinstatement

The Notice of Claims provision requires a policyowner to

notify an insurer of a claim within a specified time

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss

15

M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. 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

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

Adjust the premium payments

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 policy provisions prohibits an insurance company from incorporating external documents into an insurance policy?

Entire Contract

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

Insuring

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

Insuring clause

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

Insuring clause

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

S filed a written Proof of 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

Which of these is considered a mandatory provision?

Payment of Claims

The insuring clause

States the scope and limits of the coverage

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

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 sections of an insurance contract which limit coverage are called

exclusions

An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the

insurer dates the policy

Periodic health claim payments MUST be made at least

monthly