Questions and Answers
Which kind of health insurance policy assures renewability up to a specific age of the insured, although the company reserves the right to change the premium rate on a class basis?
According to the notice of claims provision in a health insurance policy, a claimant normally must notify the insurance company of loss within how many days after the loss occurs?
20
In health insurance policies, the purpose of a grace period is to give a policyholder extra time to?
Pay a premium after the due date.
After receiving proof of loss, all benefits other than those that are paid in periodic installments are supposed to be paid?
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Assume the following individuals are issued health insurance policies with varying renewability provisions. All other factors being equal, who would pay the highest premium?
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What must an insured do if the insurer does not furnish forms after notice of loss?
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In group health care, what is the purpose of the coordination of benefits provision?
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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?
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The time limit for filing claim disputes is addressed in which provision of an accident and health policy?
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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?
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A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called?
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A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n)?
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According to the Affordable Care Act, a grandfathered group health plan MUST cover?
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Which of the Uniform Optional Provisions covers the situation where an insurer pays a claim minus an unpaid premium?
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States that have 'no loss no gain' laws require a replacing policy to?
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A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n)?
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Which of the following is NOT a required provision in an accident and health insurance policy?
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The reinstatement provision in a health insurance policy is mandatory.
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Study Notes
Health Insurance Key Concepts
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Modified Provision
Uniform policy provisions can be altered, provided that the modifications remain as favorable to the insured as the original wording. -
Guaranteed Renewable Policies
Obligate insurers to continue coverage as long as premiums are paid; however, insurers can adjust premium rates class-wide. -
Notice of Claims Provision
Requires notice to the insurance company within 20 days after a loss occurs. -
Contract Inconsistencies
In cases of contradictory provisions, courts prioritize handwritten content, followed by typewritten, then printed materials to determine original intent. -
Grace Periods
Allow policyholders extra time to pay premiums past the due date without lapsing coverage. -
Time Payment of Claims
Benefits, except those paid in periodic installments, must be disbursed immediately after proof of loss is received. -
Noncancellable Policies
Insurers charge higher premiums for noncancellable policies due to the increased risk they assume. -
Written Proof of Loss
If forms are not provided by the insurer, the insured can submit proof of loss in any format after notifying the insurer. -
Coordination of Benefits Provision
Determines the payment responsibilities of primary and secondary insurers in group health scenarios. -
Change of Occupation Provision
Permits insurers to adjust policy benefits and premiums when the insured switches to a more hazardous job. -
Legal Actions Provision
Outlines the time frame within which claim disputes must be filed. -
Cancelable Policies
Insurers can terminate these policies anytime with written notice and must refund any advanced premiums. -
Conditionally Renewable Policies
Allow insurers to terminate coverage for specific reasons unrelated to the insured's health. -
Optional Renewability Clause
Gives insurers the right to discontinue coverage on anniversary dates or premium due dates. -
Essential Health Benefits and Lifetime Limits
Grandfathered plans must offer essential benefits without lifetime monetary limits, in compliance with the Affordable Care Act. -
Unpaid Premium Deductions
Claims will be reduced by the amount of any overdue premiums at the time the claim is paid. -
No Loss No Gain Legislation
Requires ongoing claims under an old policy to be covered by a new policy when replacing health insurance. -
Guaranteed Renewable Policy Features
Insurers can adjust premiums for these policies, but they cannot cancel them altogether. -
Optional Provision
The change of occupation provision is categorized as optional and is not mandated in accident and health insurance policies. -
Mandatory Reinstatement Provision
This provision is required in health insurance policies to ensure consistent coverage continuity following lapses.
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Description
Test your understanding of key concepts in health insurance with this quiz. Covering topics like policy provisions, claim notices, and premium payments, this quiz will help you reinforce important terms and regulations. Perfect for students or professionals working in the insurance field.
