Health Ch. 6 Health Insurance Policy Provisions

For individual health policies, insureds who pay monthly premiums are given a Grace Period of 60 days 30 days 10 days 7 days

Monthly premium health insurance policies require a 10-day grace period.

If a policyowner has a Guaranteed Renewable Health Insurance policy, the contract guarantees the continuation of coverage only a fixed price continuation of coverage and a fixed price the financial stability of the insurer

A guaranteed renewable contract guarantees the continuation of coverage only.

How many days from the date of loss must an Individual Health Insurance policyowner file Proof of Loss after receiving claim forms from the insurer? 10 days 30 days 60 days 90 days

After claim forms have been received, the policyowner has 90 days from the date of loss to file Proof of Loss with the insurer.

Lenny, who was an IT administrator, recently switched professions and is now a firefighter. He owns a Disability Income policy that pays a benefit of $5,000 per month, but he did not tell his insurer that he is now a firefighter. If Lenny is injured, how will the insurer handle his claim? deny the claim pay less than $5,000 per month pay more than $5,000 per month pay $5,000 per month

Changing to a higher-risk occupation will result in the insurer paying less than $5,000 per month on a claim.

On health insurance applications, statements made on the application are considered adhesion representations warranties guarantees

Statements made on health insurance applications are considered representations, not warranties.

The document that gives a health insurance company the authority to pay benefits directly to an insured's health care provider is the Insuring Clause Document Proof of Loss Assignment of Benefits Designation Provision

The Assignment of Benefits document provides authorization for an insured's health plan to pay benefits directly to the health care provider.

Under the Uniform Individual Policy Health Provisions law, the Legal Action provision states how much time an insured has to sue the insurer be sued by the insurer file written proof of loss hire a lawyer to handle a lawsuit

The Legal Action provision prohibits the insured from suing the insurer for at least 60 days after filing a written proof of loss.

How many days must an insured notify the insurer of a claim under the Notice of Claim provision? 10 days 20 days 30 days 45 days

The Notice of Claim provision under the Uniform Individual Health Policy Provision states that an Insured must notify the insurer of a claim within 20 days after the loss occurred.

Under a Medical Expense policy, the provision that addresses to whom benefits are paid is called Insuring Clause Notice of Claim Time of Payment of Claims Payment of Claim

The Payment of Claim provision dictates to whom benefits are paid.

The Time Limit on Certain Defenses/Incontestable clause states that the insurer can contest the accuracy of statements made on a health insurance application for up to 2 years insured can contest the validity of a claim settlement for up to 2 years insurer can request underwriting information for up to two years after policy issue insurer can contest the validity of statements made on a health insurance application only after 2 years has passed from policy issue

The Time Limit on Certain Defenses/Incontestable clause states the insurer can only challenge the accuracy of statements made on an application for health insurance not to exceed 2 years.

The required Health provision which obligates the insurer to initiate action is called the Proof of Loss provision Change of Beneficiary provision Legal Actions provision Time of Payment of Claims provision

The Time of Payment of Claims provision requires the insurance company to make a payment for a claim immediately after receiving proof of loss.

If a Disability Income policyholder is promoted to a position in the same company that inherently holds less risk of injury and notifies the insurance company of this change in occupation, the Disability Income premium will remain the same decrease increase be waived

The change to a lower-risk position will result in a decrease in the insured's policy premiums.

Mary reinstated her Individual Major Medical policy on May 10th. What will happen with Mary's coverage? Both sickness and accident coverage will begin on May 10 Both sickness and accident will begin on May 20 Accident coverage will begin May 10; Sickness coverage will begin May 20 Sickness coverage will begin May 10; Accident coverage will begin May 20

The correct answer is "Accident coverage will begin May 10; Sickness coverage will begin May 20". Coverage for a reinstated health policy begins immediately for accidents and there is a 10-day waiting period for sickness coverage.

An insurance company has how many days to deliver claim forms to an insured after the insured gives Notice of Claim? 10 days 15 days 20 days 30 days

The insurer has 15 days to provide the insured with the necessary claim forms after receiving a Notice of a Claim.

Under the Uniform Individual Health Policy Provision law, can an autopsy be required by an insurer? Yes, unless state law forbids Yes, regardless of state law No, with no exceptions No, unless a felony was committed

Under the Uniform Individual Health Policy Provision law, an insurance company can require an autopsy unless it is forbidden by state law.