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Questions and Answers
The reinstatement provision in a health insurance policy is:
The reinstatement provision in a health insurance policy is:
Disability income plans that require the insurer can NEVER change or alter premium rates are usually considered?
Disability income plans that require the insurer can NEVER change or alter premium rates are usually considered?
Noncancellable
A beneficiary change can occur?
A beneficiary change can occur?
Normally at any time during the policy term
All of the following are functions of an insuring clause EXCEPT:
All of the following are functions of an insuring clause EXCEPT:
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The time limit for filing claim disputes is addressed in which provision of an accident and health policy?
The time limit for filing claim disputes is addressed in which provision of an accident and health policy?
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In which of the following situations would the insurer be liable for a loss?
In which of the following situations would the insurer be liable for a loss?
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An insurer must furnish to a claimant forms for filing proof of loss within how many days upon receiving a notice of claim?
An insurer must furnish to a claimant forms for filing proof of loss within how many days upon receiving a notice of claim?
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In contrast to a guaranteed renewable policy, a noncancellable policy may never?
In contrast to a guaranteed renewable policy, a noncancellable policy may never?
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When an insured has submitted written proof of loss, they must wait how many days before bringing legal action against the insurer?
When an insured has submitted written proof of loss, they must wait how many days before bringing legal action against the insurer?
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Which of the following is NOT a required provision in an accident and health insurance policy?
Which of the following is NOT a required provision in an accident and health insurance policy?
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Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays how much?
Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays how much?
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Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit?
Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit?
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Which of the following is NOT a common exclusion for a medical expense policy?
Which of the following is NOT a common exclusion for a medical expense policy?
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When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?
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Written notice for a health claim must be given to the insurer how many days after the occurrence of the loss?
Written notice for a health claim must be given to the insurer how many days after the occurrence of the loss?
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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?
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?
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The reinstatement provision in a health insurance policy is...
The reinstatement provision in a health insurance policy is...
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This mandatory health policy provision states that the policy, including endorsements and attached papers, constitutes?
This mandatory health policy provision states that the policy, including endorsements and attached papers, constitutes?
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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.
Studying That Suits You
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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.
