Health Insurance Policy Provisions

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? 7 days 10 days 31 days 60 days

31 days

In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments: Whenever an insured is unable to work During the time an insured is confirmed in a hospital Following an accidental injury, but not during sickness After an insured has become totally disabled as defined in the policy

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

When does a Probationary Period provision become effective in a health insurance contract? At the policy's inception 30 days after the policy's inception When a claim is submitted When a covered loss occurs

At the policy's inception

Which of the following is NOT included in the policy face? Free look provision Name of the insured Name of the insurer Exclusions

Exclusions

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period? Gives the policy owner additional time to pay overdue premiums Gives the policy owner additional time to file a lawsuit Gives the policy owner additional time to file a claim Gives the policy owner additional time to provide proof of loss

Gives the policyowner additional time to pay overdue premiums

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract? Consideration Entire Contract Free-Look Insuring

Entire Contract

The Policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is: Grace Period Physical Examination and Autopsy Entire Contract Time Limit on Certain Defenses

Time Limit on Certain Defenses

Which Accident and Health policy provision addresses preexisting conditions? Proof of Loss Legal Actions Time Limit on Certain Defenses Payment of Claims

Time Limit on Certain Defenses

Which of these is considered a mandatory provision? Payment of Claims Insurance with Other Insurers Misstatement of Age Change of Occupation

Payment of Claims

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? 7 10 20 31

31

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? Allow her to take a tax deduction on unearned premiums Increase her policy coverage amount Decrease her policy's coverage amount Nothing

Increase her policy's coverage amount

Which health policy clause specifies the amount of benefits to be paid? Insuring Consideration Free-look Payment mode

Insuring

Which of the following health insurance policy provisions specifies the health care services a policy will provide? Insuring clause Usual, customary and reasonable clause Consideration clause Benefit clause

Insuring clause

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? Guaranteed Renewable Noncancelable Optionally Renewable Conditionally Renewable

Noncancelable

What type of renewability guarantees premium rates and renewability? Optionally Renewable Conditionally Renewable Noncancellable Guaranteed Renewable

Noncancellable

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? Free-look Reinstatement Grace Period Consideration

Reinstatement

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? File a lawsuit Submit the claim in any form Wait for the form to arrive Resubmit the request for a claim form

Submit the claim in any form

What type of rider would be added to an Accident and Health Policy if the policy owner wants to ensure the policy will continue if he/she ever becomes totally disabled? Accidental Death and Dismemberment rider Disability Income rider Guaranteed Insurability rider Waiver of Premium rider

Waiver of premium rider

Which of the following BEST describes a short-term medical expense policy? Conditionally Renewable Noncancellable Guaranteed Renewable Nonrenewable

nonrenewable

An assignment of benefits of a Health Policy: Transfer payments to someone other than the policy owner Is prohibited by state law Is allowed only on policies after 1992 Transfers right from the company to the policyholder

transfers payments to someone other than the policyowner