Life and Health Insurance: Mandator Provisions

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

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.

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

Rates by class.

An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?

Revocable.

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?

10 days (monthly premiums allow 10 days for grace periods)

Notice of loss is required in how many days?

20 Days

A deductible is

A specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits.

In a group health policy, a probationary period is intended for people who

Join the group after the effective date.

When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision

Amounts payable under the policy will reflect the insured's correct age.

A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

Claim is denied if his policy contains the Illegal Occupation provision.

5 If more than one family member covered under the same major medical policy is injured in the same accident, the family only has to pay one deductible. This is due to the

Common accident provision.

Insuring Clause

Defines the scope of coverage, as well as identifies the rights and duties of each party of the contract.

A notice of claim and proof of loss are the duties of whom?

Insured

Claim forms and the time of the payment of claim are the responsibility of whom?

Insurer.

In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost

Is not covered.

Copayment

Specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits.

A policy with a 31-day grace period implies

The policy will not lapse for 31 days if the premium is not paid when due

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day

Elimination period.

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 Claus.

Coverage is reinstated if not refused in

45 days from the date the conditional receipt was issued.

Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray?

50/50

In response to a misstatement of age on an insurance application

Benefits are adjusted per the current premium.

What type of policy allows the insurance company to cancel a policy at any time?

Cancellable

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

Exclusions.

What statement best describes the free look provision?

It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason.

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is

Monthly.

Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of loss?

Notice of Claim

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.

Coinsurance

Provides for the sharing of expenses between the insured and the insurance company. 80% the insurer pays 20% the insured pays.

Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?

Stop-loss limit

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

The insurer can increase the policy premium on an individual basis.

When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled?

The insurer is considered to be notified since the notification to agent equals notification to the insurer.

The insuring clause of a disability policy usually states all of the following EXCEPT

The method of premium payment.

Change of occupation Provision

The more hazardous the new occupation is= Reduced benefits.

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

To renew the policy until the insured has reached age 65.

A guaranteed renewable policy requires the insurer to

continue as long as premiums are paid.

An accident and health insurance policy's grace period is directly tied to

the premium payment mode.

A medical expense policy that establishes 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 similar training and experience in that geographic area is known as

Usual, customary, and reasonable.

The insured may cancel an insurance policy

At any time.

With respect to the Consideration Clause, which of the following would be considered consideration on the part of the applicant for insurance?

Payment of premium.

Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss?

Notice of Claim.