Health Insurance Policy Provisions

Under a medical expense policy, the provision that addresses to whom the insurer must pay benefits is called:

Payment of claim

What is the purpose of the Time of payment of claims provision

Prevents delayed claim payments made by the insurer

What must the policy owner provide to the insurer for validation that a loss has occurred?

Proof of loss

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

M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?

45 days

How many days from the date of loss must a health insurance policyowner file proof of loss after receiving claim forms from the insurer?

90

Mary reinstated her individual Major medical policy on may 10th. What will happen with Mary's Coverage?

Accident coverage will begin May 10; Sickness coverage will begin May 20

which of the following statements BEST describes what the legal actions 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 insurer to adjust policy benefits and rates?

Change of occupation Provision

The provision that defines to whom the insurer will pay benefits to is called:

Payment of Claims

the required health provision which obligates the insure to initiate action is called the:

Payment of Claims provision

A policy rights are limited under which beneficiary designation.

irrevocable

A Disability Income Policyowner recently submitted a claim for a chronic neck problem that has now resulted in a 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

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?

Entire Contract

Kathy has a family health insurance policy where any dependent children she has are removed from the policy once they have reached a certain age. What is this called?

Limiting Age

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

With Optionally Renewable Health policies, the insurer may

Review the policy annually and determine whether or not to renew it

Which of the following statements BEST describes an impairment rider for a medical expense policy?

Specific health conditions are excluded

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?

pay less than 5,000

For individual health policies, insureds who pay monthly premiums are given a grace period of:

10 days

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

file written proof

The policy owner has a guaranteed renewable health insurance policy, the contract guarantees:

guarantees the continuation of coverage only

The Notice of Claims provision requires a policy owner to:

notify an insurer of a claim within a specified time

The legal action provision stated how much time an insured has to:

sue the insurer

G is involved in an automobile 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