Health Insurance Unit 18 Study Guide

The insurer then had ________ days to provide her with Claim Forms

15

In most states, the policy becomes incontestable after

2 years

The incontestable clause is usually in effect after

2 years

Coverage for sickness by a reinstated policy will begin after a waiting period of __________ days

10

Number of grace period days for monthly premium mode

10 days

Barbara has a terrible skiing accident resulting in a badly broken leg which required her to be hospitalized. She had an individual Hospital Expense policy that provide reimbursement for covered expenses. In accordance with the Mandatory Provisions of her policy, Barbara had _______ days to give notice to the claim

20

The maximum time during which suit can be filed is typically how many years after written proof of loss is furnished?

3

Number of grace period days for annually premium mode

31 days

A policy must automatically be considered reinstated by an insurer ________ days after submitting and required application and/or premium

45 days

If an insured is disabled for at least 2 years, the insurer may require proof of continuance of disability every

6 months

Because the insurer needs time to respond to a claim, the law provides the insurer with a window during which the insured cannot sue to recover under a claim. This window lasts for

60 days

If the insurer fails to pay her claim, Barbara may take Legal Action no sooner than _________ days and no later than ________ years after filing her Proof of Loss

60 days, 3 years

Number of grace period days for weekly premium mode

7 days

Normally, written proofs of loss must be furnished within how many days after the loss?

90

She had a total of ______ days after her accident to provide Proof of Loss

90

Which of the following is an optional provision under the Uniform Provisions Model Act? A) Cancellation B) Physical examination and autopsy C) Reinstatement D) Legal actions

A) Cancellation

Mike Allows his policy to lapse, then applies for reinstatement using the company's required application. The company does not inform Mike either that the policy has been accepted or that the policy is being rejected. At what point can Mike consider the policy reinstated?

After 45 days

Which of the following statements is TRUE? A) A reduction is a provision that eliminates coverage for a specified condition; an exception is a provision that decreases benefits as a result of a specified condition B) An exclusion is a provision that eliminates coverage for a specified condition; a reduction is a provision that decreases benefits as a result of a specified condition C) A reduction is another term for an exception D) A reduction is a provision that eliminates coverage for a specified condition; an exclusion is a provision that decreases benefits as a result of a specified condition

B) An exclusion is a provision that eliminates coverage for a specified condition; a reduction is a provision that decreases benefits as a result of a specified condition

Which of the following is NOT a required provision under the Uniform Provisions Model Act? A) Proof of loss B) Change of occupation C) Time of payment of claims D) Grace period

B) Change of occupation

All of the following are optional health insurance policy provisions EXCEPT A) Insurance with Other Insurers B) Waiver of Premium C) Cancellation D) Other Insurance with This Insurer

B) Waiver of Premium

The insuring clause does all of the following EXCEPT A) describes the general scope of coverage B) describe the insured C) provide any definitions required D) set forth the conditions under which benefits will be paid

B) describe the insured

CeeCee's policy is guaranteed renewable. Which of the following may the insurer NOT do? A) Refuse to renew the policy when CeeCee reaches a specified age B) Refuse to renew the policy if CeeCee fails to pay the premium C) Increase the premiums on CeeCee's policy only D) Increase the premiums on all members of CeeCee's class

C) Increase the premiums on CeeCee's policy only

According to the entire contract provision, the entire contract includes all of the following EXCEPT A) any attachments B) any endorsements C) the premium payment D) the insurance policy

C) the premium payment

The Payment of Claim provision direct the insurer to pay the benefits to ____________ and the Time Payment of Claims provision tells them to pay _____________.

Insured, immediately

Which clause identifies the fact that the policyowner must pay something of value for the insurer's promise to pay benefits?

Consideration clause

George has a noncancelable policy. Which of the following may the insurer do? A) Increase the premiums on George's policy only B) cancel the policy if the insurer chooses no longer to do business in George's state C) Increase the premiums on all members of George's class D) Cancel the policy if George fails to pay premiums

D) Cancel the policy if George fails to pay premiums

Which clause identifies the components of the contract?

Entire contract clause

If Lois cancels her health insurance policy, the insurer will issue

a short-rate refund of most of the unearned premium

A reinstated policy will cover

accidents immediately and sickness after 10 days

A pro rata return is one in which the insurer returns

all of the unearned premium

Jennifer takes out an optionally renewable health policy with an annual premium due on June 14. The insurer decides it no longer wants to insure people with first names longer than five letters. The insurer may

cancel the policy, but only on June 14 of the next year

Julia worked as a race car driver until recently, when she took a job in the promotions office handling media inquiries. If she has the same health insurance, her premiums are likely to

go down

When Betty purchased her insurance policy, her age was recorded as 32 when she was actually 34. Assuming her policy includes the misstatement of age provision and the insurance company discovers this 4 years later, Betty's policy

limits will be lowered

A revocable beneficiary

may be changed without the beneficiary's consent

Carmen gets her health insurance policy on May 1, and on May 3, she decides she doesn't want it and returns it to the company. On May 6, she is hit by a car. The company will

only return any premium Carmen has paid and not any resulting claim

The optional provisions that deal with multiple insurance policies of the same type on a single insured deal with the problem of

overinsurance

Cindy has a claim for $2,000 and a past due premium of $200. The insurer will

pay the claim minus the past due premium

the grace period varies according to

premium payment frequency

All insurance policies may be canceled at any time by

the insured only

If there is no beneficiary listed on a policy, benefits will be paid to

the insured's estate

If a policy includes the provision on conformity with state statutes, and the state changes the law to be in conflict with another provision of the policy then

the provision will automatically be amended to conform to the minimum requirement of the statutes

The insurer may generally require an autopsy at its own expense unless

the state has an applicable law that forbids autopsy

Consideration for an insurance policy includes

the statements made in the application and the premium

For the waiver of premium to apply under a waiver of premium rider, the disability must be one that is

total and continues uninterrupted

Joel is hit by a car while crossing the street against the light. If Joel's policy contains the illegal occupation provision, the insurer

will pay the claim because crossing the street against the light is not a felony or a regular occupation