Health Chapter 6 Flashcards
25 Questions
100 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What does the Notice of Claims provision require a policyowner to do?

  • Notify an insurer of a claim within a specified time (correct)
  • Provide testimony as a witness
  • Wait for the insurer to contact them
  • Submit payment first

    • What is the policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending?

  • Policy Exclusions
  • Time Limit on Certain Defenses (correct)
  • Notice of Claims
  • Coverage Limits

    • What is the purpose of the Insuring clause in Health and Accident policies?

    States the scope and limits of the coverage

    When can an autopsy be performed if an individual has an Accidental Death and Dismemberment policy?

    <p>When the insurer requests it</p> Signup and view all the answers

    What type of renewability guarantees premium rates and renewability?

    <p>Guaranteed renewable</p> Signup and view all the answers

    What describes a short-term medical expense policy?

    <p>Nonrenewable</p> Signup and view all the answers

    What is the type of renewability in a Disability Income policy that cannot be canceled or have increased premiums?

    <p>Noncancellable</p> Signup and view all the answers

    What limits the time period during which an insurer may dispute a claim's validity?

    <p>Time Limit on Certain Defenses</p> Signup and view all the answers

    What provision specifies coverage may be restored if a renewal premium is late?

    <p>Reinstatement</p> Signup and view all the answers

    Who is responsible for paying the medical bills in case of an accident while intoxicated according to the Intoxicants and Narcotics exclusion?

    <p>The insured</p> Signup and view all the answers

    Which policy provision addresses preexisting conditions?

    <p>Time Limit on Certain Defenses</p> Signup and view all the answers

    What is considered a mandatory provision in a policy?

    <p>Payment of Claims</p> Signup and view all the answers

    What is a characteristic of a Conditionally Renewable Health Insurance policy?

    <p>Premiums may increase at time of renewal</p> Signup and view all the answers

    What is true about a Guaranteed Renewable Health Insurance policy?

    <p>Premiums normally increase at time of renewal</p> Signup and view all the answers

    What does the Legal Actions provision require regarding lawsuits?

    <p>An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed</p> Signup and view all the answers

    What accurately describes the Waiver of Premium provision in an Accident and Health policy?

    <p>Premiums are waived after the insured has been totally disabled for a specified time period</p> Signup and view all the answers

    How often must periodic health claim payments be made?

    <p>Monthly</p> Signup and view all the answers

    What should an insured do if the insurer does not send claims forms?

    <p>Submit the claim in any form</p> Signup and view all the answers

    Which clause details the conditions not met by the applicant who failed to complete medical history questions?

    <p>Consideration Clause</p> Signup and view all the answers

    What may an Accident and Health policyowner NOT do?

    <p>Adjust the premium payments</p> Signup and view all the answers

    What action will the insurance company take if a policyholder's age was understated on the application?

    <p>The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age</p> Signup and view all the answers

    How will the insurer handle a claim from a policyowner hospitalized from injuries sustained during a carjacking?

    <p>Claim will be denied</p> Signup and view all the answers

    What must an insured do after giving notice of loss if the forms are not furnished?

    <p>File written proof of loss</p> Signup and view all the answers

    Which disability policy provision allows an insurer to adjust benefits and rates if an insured changes to a more hazardous occupation?

    <p>Change of occupation provision</p> Signup and view all the answers

    What can insurers do with Optionally Renewable Health policies?

    <p>Review the policy annually and determine whether or not to renew it</p> Signup and view all the answers

    Study Notes

    Notice of Claims

    • Policyowner must notify insurer of a claim within a specified timeframe.

    Time Limit on Certain Defenses

    • Insurer can establish conditions the insured must meet while a claim is pending.
    • Limits time during which the insurer can dispute the claim's validity.
    • Addresses preexisting conditions.

    Insuring Clause

    • Defines the scope and limits of coverage in Health and Accident policies.

    Autopsy Clause

    • Autopsies can be performed unless prohibited by state law.

    Renewability Types

    • Guaranteed renewable policies ensure premium rates and renewability.
    • Nonrenewable policies are characteristic of short-term medical expense coverage.
    • Noncancellable policies prevent the insurer from cancelling or increasing premiums.

    Renewal Premiums

    • Conditionally renewable policies may see premiums increase at renewal.
    • Guaranteed renewable policies typically see premium increases at renewal.
    • Insured must wait at least 60 days after Proof of Loss before filing a lawsuit.

    Waiver of Premium

    • Premiums are waived after total disability for a specified time.

    Health Claim Payments

    • Periodic health claim payments must be made monthly.

    Claims Forms Provision

    • If the insurer fails to send claims forms on time, the insured can submit the claim in any form.

    Consideration Clause

    • Details conditions not met if an applicant fails to complete medical history questions.

    Policyholder Limitations

    • Accident and Health policyholders cannot adjust premium payments.

    Age Misstatements

    • Insurer adjusts benefits based on the correct age if an age misstatement is discovered.

    Major Medical Policy Claims

    • Claims related to injuries from illegal activities, such as carjacking, are likely to be denied.

    Proof of Loss

    • Insured must file written proof of loss if the insurer does not furnish forms after notice of loss.

    Change of Occupation Provision

    • Insurer may adjust benefits and rates if the insured changes to a more hazardous occupation.

    Optionally Renewable Policies

    • Insurer can review the policy annually and decide whether to renew it.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Test your knowledge with these flashcards covering Chapter 6 of Health. Each card focuses on key terms and their definitions related to health insurance policies. Perfect for reviewing and reinforcing important concepts.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser