Chapter Exam 8: Health Provisions

The Legal Actions provision of an insurance contract is designed to do all of the following, EXCEPT:

protect the producer

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

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

15

Insurers may request a hearing within ___ if their policy is rejected

20 Days

An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

31

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

Adjust the premium payments

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

A Disability Income policyowner recently submitted a claim for a 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

"A producer does not have the authority to change a policy or waive any of its provisions." The health provision that best describes this statement is called the

Entire Contract

When an insurance company 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 provision

Which of the following is NOT included in the policy face?

Exclusions

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

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

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

Insuring clause

C is the policyowner of a Comprehensive individual major medical policy. C pays an annual premium which is due September 1. If C forgets to pay the premium and is hospitalized September 10, how will the insurer handle this claim?

Pay the claim in full minus the premium due

Which of these is considered a mandatory provision?

Payment of Claims

Which is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?

Premiums may increase at time of renewal

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 policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is:

Time Limit on Certain Defenses