Questions and Answers
Insurers may request a hearing within _____ if their policy is rejected.
20 days
If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations, except:
Which policy provision specifies that coverage may be restored if a renewal premium is paid late?
Reinstatement
What type of renewability describes a Disability Income policy that cannot be canceled or have its premiums increased?
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How many days does an insurance company have to notify an applicant of a denial for reinstatement of a lapsed health insurance policy?
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Which provision specifies how long a policy owner's health coverage will remain in effect if the premium is not paid?
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Which of the following is not included in the policy face?
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What does a waiver of premium provision in health insurance do?
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What is the clause identifying which losses resulting from an accident or sickness are insured by the policy called?
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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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How will the insurer handle a claim for a chronic problem resulting in total disability if the injury was not disclosed at application?
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According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force?
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What may an insurer do with Optionally Renewable Health policies?
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What type of policy did J purchase if it can only be terminated by her and the rates will never increase?
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Which policy provision addresses pre-existing conditions?
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Which health policy clause requires attaching a copy of the application to the policy?
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What is the minimum number of days for the grace provision in an individual health insurance policy?
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What clause details the conditions that E did not meet regarding an individual health policy application?
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Health insurance benefits not covered due to an act of war are:
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Which health insurance policy provision specifies the healthcare services a policy will provide?
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Study Notes
Health Insurance Policy Provisions
- Insurers may request a hearing within 20 days if their policy is rejected.
- An autopsy can be performed in all situations related to an Accidental Death and Dismemberment policy, except where prohibited by state law.
- If a renewal premium payment is missed, the Reinstatement provision allows coverage to be restored if payment is accepted by the insurer afterward.
- A noncancellable Disability Income policy cannot be canceled or have its premiums increased.
- Notification of a denial for a reinstatement application must be made within 45 days, or the policy automatically goes back into force.
- The Grace Period provision allows health coverage to remain effective even if premiums are not paid on time.
- Exclusions are not included in the policy face, which outlines key policy components.
- The waiver of premium provision maintains coverage without premium payments after total disability of the insured, as defined in the policy.
- The Insuring clause specifies which losses from accidents or sicknesses are covered under the policy.
- The Legal Actions provision is designed to protect the insurer, not the producer.
- Claims for disabilities originating from pre-application injuries must be paid fully if not disclosed; coverage will not be affected.
- Under Mandatory Uniform Policy Provisions, a policy remains in force for a maximum of 31 days after the premium due date without payment.
- Optionally Renewable Health policies allow insurers to review and potentially decline to renew annually.
- Noncancelable policies can only be terminated by the insured and have guaranteed rates as specified in the policy.
- The Time Limit on Certain Defenses provision addresses pre-existing conditions in health policies.
- The Entire Contract clause requires an insurance company to attach the application to the policy, making it part of the contract.
- For individual health insurance policies, the minimum grace period is 31 days.
- The Consideration clause outlines the necessary conditions for coverage, including completion of medical history questions prior to policy issuance.
- Health insurance benefits related to acts of war are explicitly excluded from coverage in the contract provisions.
- The Insuring clause also details the healthcare services a policy provides.
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Description
Test your knowledge on critical health insurance policy provisions with these flashcards. This quiz covers various scenarios including policy rejection timelines and specific conditions related to Accidental Death and Dismemberment policies. Perfect for students and professionals in the insurance field.
