Health Policy Provisions, Clauses, and Riders

Insurers may change which of the following on a guaranteed renewable health insurance policy?

Rates by class

The premium charged for exercising the Guaranteed Insurability Rider is based upon the insured's

Attained age

Items stipulated in the contract that the insurer will not provide coverage are found in the

Exclusions

Which of the following riders would NOT increase the premium for policy owner?

Impairment Rider

A guaranteed renewable health insurance policy allows the

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

In respect to the consideration clause, which of the following is consideration on the part of the insurer?

Promising to pay in accordance with the contract terms

Which of the following is NOT a feature of guaranteed renewable provision?

The insurer can increase the policy premium on an individual basis

An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?

Time of Payment of Claims

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of Claims

When an insurer issued an individual health insurance policy that is guaranteed renewable, the insurer agrees

To renew the policy until the insured has reached age 65

A health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?

immediately

Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it?

Free look period

A medical expense policy that Rasta lushes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similiar training and experience in that geographic area is known as

Usual, customary, and reasonable

When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should

Adjust the benefit in accordance with the decreased risk

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the

Entire contract clause