Questions and Answers
Which of the following statements about a Guaranteed Renewable Health Insurance policy is correct?
When does a Probationary Period provision become effective in a health insurance contract?
At the policy's inception.
Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions?
Entire Contract.
How will the insurer most likely handle a claim from P, a Major Medical policy owner hospitalized from injuries sustained while participating in a carjacking?
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Periodic health claim payments must be made at least:
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What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?
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What type of renewability guarantees premium rates and renewability?
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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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Which of these is considered a mandatory provision?
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After an insured gives notice of loss, what must they do if the insurer does not furnish forms?
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The provision that limits the time period during which the company may dispute a claim's validity is called:
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An insurance company normally has 2 years to contest information provided on an accident and health application. This period begins on the date that the:
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What is the purpose of the Time of Payment of Claims provision?
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Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?
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According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?
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The provision that defines to whom the insurer will pay benefits to is called:
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Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy?
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What is the purpose of the insuring clause?
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The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is:
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What action will the insurance company take if J, an Accidental Death and Dismemberment policyholder, is found to have understated his age by ten years?
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Study Notes
Guaranteed Renewable Health Insurance
- Premiums can increase at the time of renewal.
Probationary Period Provision
- Effective at the inception of the policy.
- No benefits are payable during this period.
Entire Contract Provision
- Producer lacks authority to change the policy or waive provisions.
Policy Claims and Illegal Activities
- Claims are denied if injuries occur during the commission of an illegal act.
Periodic Health Claim Payments
- Must be made at least monthly under individual health policies.
Conditionally Renewable Health Insurance
- Premiums may increase upon renewal.
Non-Cancelable Policies
- Guarantee both premium rates and renewability.
Change of Occupation Provision
- Allows insurers to adjust benefits and rates if the insured takes up a more hazardous job.
Mandatory Policy Provisions
- Payment of claims is a mandatory provision that directs where benefits go.
Proof of Loss Requirement
- If an insurer does not provide forms post-notice of loss, the insured can file written proof in any form.
Time Limit on Certain Defenses
- Limits the timeframe insurers have to contest the validity of claims based on misrepresentations on the application.
Contest Period for Applications
- Insurers have two years to contest information in an accident and health application, starting from the dating of the policy.
Time of Payment of Claims Provision
- Prevents delays in payment from the insurer for claims.
Waiver of Premium Provision
- Premiums are waived if the insured is totally disabled for a specified duration.
Disability Income Benefit Payments
- Must be paid no less frequently than monthly.
Payment of Claims Provision
- Defines the beneficiaries of the claims.
Entire Contract Provision and External Documents
- Prohibits insurers from incorporating external documents into health insurance policies.
Insuring Clause
- Outlines the scope and limits of coverage.
Time Limit on Certain Defenses for Claims
- Establishes conditions insurers can impose while a claim is pending.
Adjustments in Benefits Due to Misstatement
- Insurers will adjust benefits in cases where the insured's age was understated on the application.
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Description
Test your knowledge on the various provisions of health insurance policies including guaranteed renewable and non-cancelable options. This quiz covers essential elements such as mandatory provisions, premium adjustments, and claims related to illegal activities. Perfect for anyone studying health insurance fundamentals.
