Health Insurance Chapter 6 Quiz
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Questions and Answers

Periodic health claim payments must be made at least?

monthly

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?

Waiver of Premium Rider

Which Accident and Health policy provision addresses preexisting conditions?

time limit on certain defenses

How will the insurer handle a claim for a chronic neck problem that occurred before the application was taken?

<p>Claim will be paid and coverage will remain in force.</p> Signup and view all the answers

Under the Change of Occupation provision, which of the following actions may an insurance company take if the policyholder chooses a less hazardous occupation?

<p>Increase her policy's coverage amount</p> Signup and view all the answers

A disability income policy that only the policyowner can terminate and which the rates will never go up is considered to be?

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

What must the policyowner provide to the insurer for validation that a loss has occurred?

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

An autopsy can be performed on a deceased individual covered under an accidental death policy EXCEPT when?

<p>The state prohibits this by law</p> Signup and view all the answers

Insurers may request a hearing within _____ if their policy is rejected?

<p>20 Days</p> Signup and view all the answers

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

<p>grace period</p> Signup and view all the answers

What is the minimum number of days for the Grace Period provision in an annual policy?

<p>31 Days</p> Signup and view all the answers

What 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?

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

What is considered a mandatory provision in health insurance?

<p>payment of claims</p> Signup and view all the answers

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

<p>Protect the producer</p> Signup and view all the answers

The Legal Actions provision of an insurance contract is designed to do what?

<p>All of the above</p> Signup and view all the answers

Which policy provision specifies that coverage may be restored when a renewal premium is accepted after the grace period?

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

The provision that defines to whom the insurer will pay benefits is called?

<p>payment of claims</p> Signup and view all the answers

What type of policy requires renewal by the insurer, allowing premium increases only applied to the entire class of insureds?

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

Which clause details the conditions that an applicant did not meet regarding medical history?

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

Which is considered the time period after a Health Policy is issued during which no benefits are provided for illness?

<p>probationary period</p> Signup and view all the answers

What does the insuring clause do?

<p>states the scope and limits of the coverage</p> Signup and view all the answers

The sections of an insurance contract which limit coverage are called?

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

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

<p>20 Days</p> Signup and view all the answers

What action will the insurance company take if an Accidental Death and Dismemberment policyholder's age was understated?

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

In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments after what condition?

<p>after an insured has become totally disabled as defined by the policy</p> Signup and view all the answers

With Optionally Renewable Health policies, what can the insurer do?

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

What element makes the application part of the contract between the insured and the insurer?

<p>entire contract provision</p> Signup and view all the answers

How will the insurer most likely handle a claim for injuries sustained during an illegal activity like carjacking?

<p>claim will be denied</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 specific period of time</p> Signup and view all the answers

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

<p>prevents delayed claim payments made by the insurer</p> Signup and view all the answers

How many days from the reinstatement application date does the insurance company have to notify the insured of a denial before the policy will be automatically placed back in force?

<p>45 Days</p> Signup and view all the answers

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

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

What is not included in the policy face?

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

What is included in the policy face?

<p>free look provision, name of the insurer, name of the insured</p> Signup and view all the answers

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

<p>time limit on certain defenses</p> Signup and view all the answers

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

<p>insured must be under a physician's care</p> Signup and view all the answers

Study Notes

Health Insurance Policy Provisions

  • Periodic health claim payments must be made monthly.
  • A Waiver of Premium Rider ensures continuation of the policy if the policyowner becomes totally disabled.
  • The provision addressing preexisting conditions in Accident and Health policies is known as the time limit on certain defenses.
  • A claim for a chronic condition that was not disclosed may be paid once the policy enters the incontestable period, typically after 2-3 years.
  • The Change of Occupation provision allows the insurer to increase coverage if the policyowner opts for a less hazardous occupation.
  • A noncancellable disability income policy can only be terminated by the policyowner, with fixed rates for the duration of the policy.
  • Policyowners must provide proof of loss to validate that a loss has occurred.
  • Autopsies related to accidental death policies may only be performed if state law does not prohibit them.
  • Insurers have 20 days to request a hearing if their policy is rejected.
  • The grace period provision specifies how long health coverage remains effective after the premium due date has passed.
  • The minimum grace period for annual health insurance premiums is 31 days.
  • Guaranteed renewable policies allow coverage until age 65, with the right for the insurer to change premiums based on risk class.
  • Mandatory provisions in policies include the payment of claims.
  • The Legal Actions provision establishes guidelines for pursuing legal action against insurers and protects both parties during the claim process.
  • Reinstatement provision allows coverage restoration after late premium payment acceptance by the insurer.
  • The payment of claims provision specifies who receives benefits from insurance claims.
  • Guaranteed renewable health policies require renewal with premium increases allowed only for entire classes of insureds.
  • The consideration clause requires the completion of medical history questions and payment of the initial premium for valid coverage.
  • A probationary period is defined as the time during which no benefits are provided for illness after a Health Policy is issued.
  • The insuring clause outlines the scope and limits of coverage in a health insurance policy.
  • Exclusions are specific sections in an insurance contract that limit coverage.
  • Insured individuals must notify their insurer of a medical claim within 20 days following an accident.
  • If a policyholder's age is understated on the application, the insurer adjusts the benefits based on the actual age at the time of underwriting.
  • Waiver of premium provisions keep coverage active without payments after the insured becomes totally disabled.
  • Optionally Renewable Health policies allow insurers to determine renewal annually.
  • The entire contract provision integrates the application as part of the insurance contract.
  • Claims related to participating in illegal activities, such as carjacking, are typically denied.
  • Waiver of premium provision details the conditions when premiums are waived after total disability.
  • The Time of Payment of Claims provision prevents delays in claims processing by the insurer.
  • An insurance company must notify an insured of denial within 45 days of the reinstatement application before the policy is reinstated automatically.
  • A Conditionally Renewable Health Insurance Policy may have increased premiums upon renewal.
  • The policy face includes essential elements such as the free look provision and details on the insurer and insured.
  • The time limit on certain defenses provision allows insurers to establish conditions that must be met while a claim is pending.
  • For eligibility under the waiver of premium provision, the insured must be under a physician's care.

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Description

Test your knowledge on Health Insurance Policy Provisions with this quiz focused on Chapter 6. Review key terms and concepts related to periodic payments and riders in Accident and Health policies. Perfect for students and professionals in the field of health insurance.

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