Chapter 17- Health Insurance Provisions
7. According to Required Provision 4, when an insured applies for reinstatement of a health policy and receives a conditional receipt, how long does the insurer have to approve or deny
45 days of the date of application.
12. Bart is injured and provides notice of a health claim to the Insurer. He later receives the required claim forms. Within how many days of the loss must Bart file proof of loss with the insurance company
90.
20. The Notice of Claim provision states that the insured notify the ins. Co. within___ days of a claim
20 days
56. An insured pays premiums on an annual basis for an individual health ins. Policy. What is the MINIMUM number of days for the Grace Period provision
31
14. Required Provision 3 states that the minimum grace period for all policies (except those with monthly or weekly premium modes is
31 days.
61. Required Provision 3 states that the minimum grace period for all policies (except those with monthly or weekly premium modes) is
31 days.
29. M's ins. Co. denied a reinstatement application for her lapsed health ins. Policy. The co. did not notify M of this denial. How many days from the reinstatement application date does the ins. Co. have to notify M of the denial before the policy will be automatically placed back in force
45 days
21. With Accidental Death and Dissmemberment policies, what is the purpose of the Grace period
Gives the policyowner addtional time to pay past due premiums
35. Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due
Grace period
31. Which of the following health ins. Policy provisions specifies the health care services a policy will provide
Insuring clause
5. The clause in an Accident Health policy which defines the benefit amounts the insurer will pay is called the
Insuring clause.
57. 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
42. Which of the following BEST describes a short-term medical expense policy
Non-renewable.
19. If an ins. Co. issues a Disability Income policy that it cannot cancel or for which it cannot increase premium, the type of renewability that best describes this policy is called
Noncancellable
49. S filed a Proof of Loss for a Disability Income claim on September 1. The ins. Co. did not respond to the claim. S can take legal action against the insurer beginning
November 1.
43. The provision that defines to whom the insurer will pay benefits to is called
Payment of Claims
55. Which of these is considered a mandatory provision
Payment of claims
45. Which of the following statements about a Guaranteed Renewal Health insurance policy is CORRECT
Policy normally increase a the time of renewal.
50. 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.
38. The policy provision that entitles the Insurer to establish conditions the insured must meet while a claim is pending is
Time Limit on Certain Defenses.
60. If an individual has an Accidental Death and Dismemberment policy and dies, an autoposy can be performed in all of these EXCEPT
When the State prohibits this by law.
28. A disability policy that must be renewed, cannot be canceled until age 65, and may not have an increase in premium for any reason is called
noncancellable policy
11. A disability policy that must be renewed, cannot be cancelled until age 65, and may not have an increase in premium for any reason is called a
noncancellation policy
25. The Notice of Claim provision requires a policyowner to
notify an insurer of a claim within a specified time
4. The Notice of Claim Provision states that the Insured notify the insurance company within ___ days of a claim
20
62. Which of the following statements describes what an Accident and Health policyowner may NOT do
Adjust the premium payments
6. Which of the following statements is NOT correct
Agents are allowed to waive certain policy provisions.
15. The waiver of premium provision normally excludes which of the following disability acts
All of the above.
39. The waiver or premium provision normally excludes which of the following disabling acts
All of these
27. Which of the following BEST describes what the Legal Actions provision of an Accident Health policy requires
An insured must WAIT at least 60 days after proof of loss has been submitted before a lawsuit can be filed.
23. When does a Probationary Period provision become effective in a health ins. Contract
At the policy's inception.
48. P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim
Claim will be denied
30. The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called
Insuring clause
59. A Disability Income policyowner recently submitted a claim for chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim
Claim will be paid and coverage will remain in force.
52. An ins. Co. 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 ins. Co. anyway. A few weeks alter, E suffers a heart attack and is hospitalized without completig 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
40. Which health policy clause stipulates that an ins. Co. must attach a copy of the application to the policy that it is part of the contract
Entire contract
44. When an ins. co. 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
46. What type of renewability guarantees premium rates and renewability
Guaranteed renewable
17. 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
32. T files a claim on his Accident and Health Policy after being treated for an illness. The ins. Co. believes T misrepresented his actual health on the initial ins. Application and is therefore disputing the claim's validity. The provision that limits the time period during which the co. may dispute a claim's validity is called
Insuring
18. What is considered to be a characteristic of a Conditionally renewable Health insurance poliy
Premiums may increase at time of renewal.
33. What is the purpose of the Time of Payment of Claims provision
Prevents delayed claim payments made by the Insurer.
64. What is the purpose of the Time of Payment of Claims provision
Prevents delayed claim payments made by the insurer
54. What must the policyower provide to the insurer for validation that a loss has occurred
Proof of Loss
51. 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
58. Which of the following statements describes the purpose of the Insuring Clause in Health and Accident policies
States the scope and limits of coverage
16. What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision
Submit the claim in any form
53. What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision
Submit the claim in any form
24. G is involved in an auto 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
9. Amy owns a disability income policy with a noncancellable renewal provision. Which of the following is guaranteed in her policy
The coverage and premium rate are guaranteed.
34. J an Accidental 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 10 year. Which of the following actions will the ins. Co. take
The insurer will adjust the benefit to what the premiums paid would have purchased at the time of the insured's actual age.
47. Which of the following statements about a non-cancellable policy is FALSE
The premium CAN be increased over time
2. Which of the following statements about a noncancellable policy are FALSE
The premium rate CAN be increased over time
63. Which Accident and Health policy provision addresses pre-existing conditions
Time Limit on Certain Defenses
41. According to Required Provision 4, when an insured applies for reinstatement of a health policy and receives a conditional receipt, how long does the insurer have to approve or deny
Within 45 days of the date of the application
10. Anita is an office clerk at the time she purchases a Disability Income policy. She later changes her career toa king crab fisherman. If she ever becomes injured on the boat, the Change of Occupation provision states that the insurer can
adjust the benefits.
37. After the ins. Co. receives a written request, an insured may have health ins. Benefits paid to
anyone designated by the Insured
1. After the insurance co. receives a written request, an insured may have health insurance benefits paid to
anyone designated by the insured.
22. Health Ins. benefits NOT covered due to an act of War are
excluded by the insurer in the contract provisions.
13. On November 10, Ozzie Major Medical policy is reinstated. He is later injured in an automobile accident on Novemer 13 and immediately hospitalized. Ozzie is eligible for
full benefits (After health policy's reinstatement are fully covered immediately. Illnesses require a 10 day wait period).
3. Under a Guaranteed Renewable health insurance policy; the insurer
may cancel the policy for nonpayment only.
36. Periodic benefit payments must made no less frequently than
monthly
8. Periodic benefit payments must be made no less frequently than
monthly
26. With Optionally Renewable Health policies, the insurer may
review the policy annually and determine whether or not to renew it