Health Provisions Exam Review

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called

noncancellable

The Notice of Claims provision requires a policyowner to

notify an insurer of a claim within a specified time

The Legal Actions provision of an insurance contract is designed to do all of the following EXCEPT

protect the producer

What type of renewability guarantees premium rates and renewability?

Noncanellable

Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?

Premiums are waived after the insured has been totally disabled for a specified time period

What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?

Premiums may increase at time of renewal

Periodic health claim payments MUST be made at least

monthly

An insured must notify an insurer of a medical claim within how many days after an accident?

20

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?

31

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?

31 days

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

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

A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in 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 type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class?

Guaranteed Renewable

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?

Increase her policy's coverage amount

Which health policy clause specifies the amount of benefits to be paid?

Insuring

What is the purpose of the Time of Payment of Claims provision?

Prevents delayed claim payments made by the insurer

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

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?

The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age

Which Accident and Health policy provision addresses preexisting conditions?

Time Limit on Certain Defenses

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called

Time limit on Certain Defenses

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

Which of the following is NOT included in the policy face?

Exclusions

Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due?

Grace period

The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the

Insuring clause

Which of the following health insurance policy provisions specifies the health care services a policy will provide?

Insuring clause

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning

November 1st -60 days after written proof of loss before legal action can be brought against the company

The insuring clause

States the scope and limits of the coverage

When does a Probationary Period provision become effective in a health insurance contract?

at the policy's inception

P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim?

claim will be denied

Health insurance benefits NOT covered due to an act of war are

excluded by the insurer in the contract provisions

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

file written proof of loss

What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision?

insured must be under a physician's care

An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the

insurer dates the policy

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