Questions and Answers
What does the Notice of Claims provision require a policyowner to do?
What is the policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending?
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?
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What type of renewability guarantees premium rates and renewability?
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What describes a short-term medical expense policy?
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What is the type of renewability in a Disability Income policy that cannot be canceled or have increased premiums?
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What limits the time period during which an insurer may dispute a claim's validity?
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What provision specifies coverage may be restored if a renewal premium is late?
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Who is responsible for paying the medical bills in case of an accident while intoxicated according to the Intoxicants and Narcotics exclusion?
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Which policy provision addresses preexisting conditions?
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What is considered a mandatory provision in a policy?
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What is a characteristic of a Conditionally Renewable Health Insurance policy?
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What is true about a Guaranteed Renewable Health Insurance policy?
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What does the Legal Actions provision require regarding lawsuits?
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What accurately describes the Waiver of Premium provision in an Accident and Health policy?
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How often must periodic health claim payments be made?
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What should an insured do if the insurer does not send claims forms?
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Which clause details the conditions not met by the applicant who failed to complete medical history questions?
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What may an Accident and Health policyowner NOT do?
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What action will the insurance company take if a policyholder's age was understated on the application?
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How will the insurer handle a claim from a policyowner hospitalized from injuries sustained during a carjacking?
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What must an insured do after giving notice of loss if the forms are not furnished?
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Which disability policy provision allows an insurer to adjust benefits and rates if an insured changes to a more hazardous occupation?
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What can insurers do with Optionally Renewable Health policies?
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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.
Legal Actions Provision
- 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.
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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.
