Ch 8 (Health Provisions)
Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?
premiums are waived after the insured has been totally disabled for a specified time period
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
31 days
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
The legal actions provision of an insurance contract is not designed to do what?
protect the producer
With Optionally Renewable Health policies, the insurer may
review the policy annually and determine whether or not to renew it
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
X is insured with a disability income policy that provides coverage until age 65. This policy allows the insurer to change the premium rate for the overall risk class assigned. Which of these renewability features does this policy contain?
Guaranteed Renewable
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
What is the purpose of the Time of Payment of Claims provision?
Prevents delayed claim payments made by the insurer
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
Under and individual Health Insurance policy, the Time Limity of Certain Defenses provision states that nonfraudulent misstatements first become incontestable two years
from the date the policy was issued
The insuring clause
states the scope and limits of the coverage
S is the policyowner of a major medical policy. the premiums are paid monthly and due on the 1st of each month. S fails to make September's payment and is hospitalized October 15th. when S files the claim for this hospitalization, the insurer will likely
Deny the claim
Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy?
Entire Contract
Which of the following is NOT included in the policy face?
Exclusions
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
T applied for a Disability Income policy and has a history of back injuries. The insurer issued the policy with a statement that excludes coverage for back injuries. This statement is called a(n)
impairment rider
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
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
