Questions and Answers
Health insurance benefits NOT covered due to an act of war are?
According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?
What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?
Submit the claim in any form
The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is?
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The provision that defines to whom the insurer will pay benefits to is called?
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Premiums for a Guaranteed Renewable Health Insurance policy normally increase at the time of renewal.
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With Optionally Renewable Health policies, the insurer may?
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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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The Legal Actions provision of an insurance contract is designed to do all of the following EXCEPT?
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Study Notes
Health Insurance Policy Provisions
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Health insurance benefits resulting from acts of war are specifically excluded by insurers in policy provisions.
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Under the Time Payment of Claims provision, Disability Income benefits must be paid at least monthly, regardless of other possible timeframes such as 30, 45, or 60 days.
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If an insurer fails to provide claims forms within the designated timeframe, the insured can submit their claim in any acceptable format, which must be recognized as adequate proof of loss by the insurer.
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The Time Limit on Certain Defenses provision allows insurers to establish conditions an insured must meet while a claim is under consideration, limiting the time frame for denying claims based on misstatements.
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The Payment of Claims provision specifies the beneficiaries who will receive payouts from health insurance claims, defining who gets the benefits.
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Guaranteed Renewable Health Insurance policies typically see premiums increase upon renewal, allowing insurers to adjust costs over time.
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In Optionally Renewable Health policies, insurers have the discretion to review and decide on policy renewals annually, providing them flexibility in continuing coverage.
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The Time of Payment of Claims provision is crucial for preventing insurers from delaying claim payments, ensuring timely financial support for insured individuals.
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The Waiver of Premium provision allows for the cessation of premium payments after the insured has been totally disabled for a designated time, providing financial relief during periods of inability to work.
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The Legal Actions provision in an insurance contract serves various protective functions but does not protect the insurance producer, focusing instead on the rights of the insured.
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Description
Test your knowledge on health insurance policy provisions with these flashcards. Learn key terms and definitions that are critical for understanding exclusions and payment of claims in insurance contracts.
