Chapter exam six health insurance policy provisions

An insurer must provide an insured with claims forms within how many days after receiving notice of loss

15 days

Insurers may request a hearing within——— if Their policy is rejected

20 days

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

And insured pays premiums on an annual basis for an individual health insurance policy. What is the maximum number of days for the grace. Provision?

31days

Emz insurance company denies a reinstatement application for her lapsed health insurance policy the company did not notify him of this delay. How Many days from The reinstatement application date does the insurance company have to notify him of the denial before the policy will be automatically placed back in force

45 days

In health insurance policies, a waiver of premium provision keeps the coverage in force with out premiums payments

After an insured has become totally disabled as defined in the policy

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

When an insured changes to a more hazardous occupation which disability policy provision allows an insured to adjust policy benefits and rates

Change of occupation provision

He is a major medical policy owner who is hospitalized as a Result of injuring sub stain from participating in a carjacking. How were the insurer most likely handle this claim?

Claim will be denied

An insurance company receives E 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 A few weeks later, he suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. He is not insured. Which of the following clauses details the conditions That eat did not meet?

Consideration clause

And insurance company receives is application for an individual health policy. He did not complete all of the medical history questions because she did not remember the exact dates. He signed the policy and submitted it to the insurance company anyway. A few weeks later is suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. He is not insured. Which of the following clauses details the conditions that we did not meet?

Consideration clause

Which of the following health policy provisions states that the producer does not have the authority to change the policy or waive any of its provisions?

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 policy provisions prohibits an insurance company from incorporating X ternal documents into an insurance policy?

Entire contract

Dissection of an insurance contract that limits coverage are called

Exclusions

Which of the following is not included in the policy face

Exclusions

After an insured gives notice of loss what most here she do if the insured does not furnish forms?

File written proof of loss

With accidental death and dismemberment policy is what is the purpose of the grace period?

Gives the policy on her additional time to pay overdue premiums

Which of the following provisions specifies how long a policy owners have coverage will remain in fact if the policy owner does not pay the premium when it's due?

Grace period

Kay has an insurance policy that must be renewed by the insurer and the premiums can only be increased if applied To the entire class of insurance. This type of policy is considered what

Guaranteed renewable

Which type of renewability best describes a disability income policy that covers an individual until the age 65 but the insurer has the right to change the premium rate for the overall risk class?

Guaranteed renewable

Non-cancelable policy

Guarantees premium rates and renewability, other major type of disability policy. These policies can never be cancelled as long as premiums are paid, and premiums are guaranteed not to increase. See guaranteed renewable for information about the other major type of disability policy.

T owns an accident and health policy and notifies her insurance copy that she has chosen a less hair is it his occupation. Under the change of occupation provision which of the following actions me her insurance company take?

Increase her policies coverage amount

And insurance company normally has two years to can test information provided on an accident and health application there's two year period begins on the date that

Insured dates the policy

What is the initial requirement of an insured to become eligible for benefits under the waiver of premium provision

Insured must be under a physician's care

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

Insuring

Because in an accident and health policy Which defines the benefit amounts the insurer will pay is called the

Insuring clause

According to the time payment of claims provision the insurance paid disability income benefits no less frequently than which of the following options

Monthly

If an Insurance company issues a disability income policy that It canNot cancel or for which it cannot increased premiums the type of renewability that best describes this policy is called

Non-cancelable

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

They notice of claims provision requires a policy owner to

Notify and ensure of a claim with in specified time

The notice of claims provision requires a policy owner to

Notify and ensure of a claim within a specified time

S filed a written proof of loss for a disability income claim on September 1 the insurance company did not respond to the clean as can take legal action against the insurers beginning

November 1 /60 days

Which of these is considered a mandatory provision?

Payment of Claims

The provision that defines family insurance will pay benefits to is called

Payment of claims

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

What is considered to be a characteristic of a conditional renewable Health insurance policy?

Premiums may increase at time of renewal

Which of the following statements about a guaranteed renewability health insurance policy is correct?

Premiums normally increase at time of renewal

What must the policy owner provide to the insurerFor verification that loss has occurred?

Proof of loss

A legal action provision of an insurance contract is designed to do all of the following

Protect the producer

K failed to pay a renewal premium within the time granted by the insurer. Kim then send in a payment which they will ensure subsequently excepts. Which policy provisions specifies that coverage may be restored in this situation?

Reinstatement

What should and insured do if the insured does not send claim forms within a time period Set forth in a health policies claims form provision?

Submit the claim in any form

G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the intoxicants Exclusion Angie's policy who is responsible for paying medical bills?

The insured G

J, An accidental death and dismemberment policy holder, dies after injury sub stain in an accident. Jay's a bitch is stated on the application five years ago was found to be understated by 10 years which of the following actions were the insurance company take?

The insurer will adjust the benefit at what the premiums paid would have been purchased at the insured accurate age

A disability income policy owner 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 five years Prior. The neck injury was never a disclosed To the insurer at the time of application. How were the insurance or handle the claim?

They claim Will be paid and coverage will remain in force...... after a policy has been in force for two years it enters the incontestable. In which the insurer may not denied claim based on information not disclosed at time of application

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

Time limit on certain defenses

Which accident and health policy provisions addresses pre-existing conditions?

Time limit on certain defenses

And assignment of benefits of a health policy

Transfers payments to someone other than the policy owner

What type of rider would be added to an accident and health policy if the policy owner wants to ensure the policy working here she becomes

Waiver of premium rider

If an individual has an accidental death and dismemberment policy and dies and I'll Topsey can be performed in all of these situations except

When the state prohibits this by law

Periodic health claim payments must be made at least

monthly

Which of the following best describes a short term medical expense policy?

nonrenewable

Entire contract provision

the policy owner is entitled to the entire contract so that he knows any riders or waivers