Health Insurance Concepts Chapter 6

Questions and Answers

The reinstatement provision in a health insurance policy is:

Discretionary

Voluntary

Mandatory (correct)

Optional

Disability income plans that require the insurer can NEVER change or alter premium rates are usually considered?

Noncancellable

A beneficiary change can occur?

Normally at any time during the policy term

All of the following are functions of an insuring clause EXCEPT:

Primarily describes the free-look period Signup and view all the answers

The time limit for filing claim disputes is addressed in which provision of an accident and health policy?

Legal actions Signup and view all the answers

In which of the following situations would the insurer be liable for a loss?

The insured suffered an injury as an innocent bystander during a bank robbery Signup and view all the answers

An insurer must furnish to a claimant forms for filing proof of loss within how many days upon receiving a notice of claim?

15 Signup and view all the answers

In contrast to a guaranteed renewable policy, a noncancellable policy may never?

Raise premiums Signup and view all the answers

When an insured has submitted written proof of loss, they must wait how many days before bringing legal action against the insurer?

60 Signup and view all the answers

Which of the following is NOT a required provision in an accident and health insurance policy?

Change of occupation Signup and view all the answers

Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays how much?

$400 Signup and view all the answers

Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit?

Increase the premiums on an individual basis Signup and view all the answers

Which of the following is NOT a common exclusion for a medical expense policy?

Physical therapy Signup and view all the answers

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 Signup and view all the answers

Written notice for a health claim must be given to the insurer how many days after the occurrence of the loss?

20 days Signup and view all the answers

The type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called?

Cancelable Signup and view all the answers

The reinstatement provision in a health insurance policy is...

Mandatory Signup and view all the answers

This mandatory health policy provision states that the policy, including endorsements and attached papers, constitutes?

The entire insurance contracts between the parties Signup and view all the answers

Study Notes

Health Insurance Provisions and Definitions

The reinstatement provision in health insurance is mandatory, ensuring policies are reinstated under specified conditions.
Disability income plans labeled as noncancellable ensure that premium rates cannot be changed by insurers.
Beneficiary changes in a policy can be made at any point during the policy term.

Insuring Clause Functions

Insuring clauses state the conditions under which a policy will pay benefits and outline the benefits provided.
They define the policy's scope and limits of coverage but do not primarily describe the free-look period.

Claim Filing and Legal Actions

The legal actions provision addresses the time limit for filing claim disputes in accident and health policies.
Insurers must provide claimants with forms for filing proof of loss within 15 days of receiving notice of a claim.
After submitting proof of loss, insureds must wait 60 days before initiating legal action against the insurer.

Policy Renewability and Premium Adjustments

A noncancellable policy cannot have its premiums raised at any time, unlike a guaranteed renewable policy.
In guaranteed renewable policies, insurers cannot increase premiums on an individual basis.

Exclusions and Claims

Common exclusions in medical expense policies often include acts of war, on-the-job injuries, and self-inflicted injuries; however, physical therapy is typically not excluded.
An unpaid premium allows insurers to adjust claims, exemplified by the situation where a $500 claim is reduced to $400 due to a $100 past due premium.

Change of Occupation and Other Considerations

When an insured changes to a more hazardous occupation, the change of occupation provision allows for adjustments in policy benefits and rates.
Written notice for a health claim must be submitted within 20 days following the occurrence of a loss.
A cancelable policy allows insurers to send cancellation notices to the insured during the policy term, unlike noncancellable policies.

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Description

Test your knowledge of key concepts in health insurance with this flashcard quiz based on Chapter 6. Learn about reinstatement provisions, disability income plans, and beneficiary changes as you prepare for your examination.