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Questions and Answers
What does a Guaranteed Renewable provision allow?
What does a Guaranteed Renewable provision allow?
Which type of health insurance plan charges a premium that cannot be increased?
Which type of health insurance plan charges a premium that cannot be increased?
Which health insurance provision requires that the application becomes part of the policy?
Which health insurance provision requires that the application becomes part of the policy?
When must a health insurer provide a proof of loss form?
When must a health insurer provide a proof of loss form?
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Under what circumstance does an accident and health insurer have the right to request an autopsy?
Under what circumstance does an accident and health insurer have the right to request an autopsy?
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An insured must notify an insurer of a medical claim within how many days after an accident?
An insured must notify an insurer of a medical claim within how many days after an accident?
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What does the 'time limit on certain defenses' clause state?
What does the 'time limit on certain defenses' clause state?
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The agent has the authority to change the policy or waive its provisions.
The agent has the authority to change the policy or waive its provisions.
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What type of policy is Tim covered by if it may not be changed by the insurer up to a stated age?
What type of policy is Tim covered by if it may not be changed by the insurer up to a stated age?
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What happens when the insured has other health coverage prior to a claim?
What happens when the insured has other health coverage prior to a claim?
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Which clause specifies the amount of benefits to be paid in a health policy?
Which clause specifies the amount of benefits to be paid in a health policy?
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Which provision sets forth a health insurance policy's premium requirements?
Which provision sets forth a health insurance policy's premium requirements?
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Disability income insurance typically covers disabilities from active military duty.
Disability income insurance typically covers disabilities from active military duty.
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How is an insured's accident and health claim handled during the policy's grace period?
How is an insured's accident and health claim handled during the policy's grace period?
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What effect will a change of occupation provision have if an insured performs a more hazardous occupation?
What effect will a change of occupation provision have if an insured performs a more hazardous occupation?
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Who may terminate coverage under a cancelable health insurance policy?
Who may terminate coverage under a cancelable health insurance policy?
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What may happen under the Change of Occupation provision if the insured changes to a less hazardous occupation?
What may happen under the Change of Occupation provision if the insured changes to a less hazardous occupation?
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How frequently must periodic health claim payments be made?
How frequently must periodic health claim payments be made?
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How long must the insured wait after providing written proof of loss before bringing legal action against the insurer?
How long must the insured wait after providing written proof of loss before bringing legal action against the insurer?
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What constitutes the 'entire contract'?
What constitutes the 'entire contract'?
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What is the insured's consideration given for a health insurance policy?
What is the insured's consideration given for a health insurance policy?
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How much will the insurer pay if the benefit payable is $500 and the overdue premium is $200?
How much will the insurer pay if the benefit payable is $500 and the overdue premium is $200?
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Who is protected with the 'other insurance with this insurer' provision?
Who is protected with the 'other insurance with this insurer' provision?
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How must an insured cancel a health insurance policy?
How must an insured cancel a health insurance policy?
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Under what conditions can an insurance company refuse renewal of a conditionally renewable policy?
Under what conditions can an insurance company refuse renewal of a conditionally renewable policy?
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Study Notes
Health Insurance Policy Provisions
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Guaranteed Renewable: Premiums can only be increased based on the rate class.
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Noncancelable Plans: Health insurance plans where premiums cannot be increased.
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Entire Contract Clause: Provision that integrates the application into the actual insurance policy.
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Proof of Loss Form: Insurers must provide this form within 15 days of receiving notice of loss.
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Autopsy Request Rights: Insurers can request an autopsy when not prohibited by state law.
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Claim Notification: An insured must inform the insurer of a medical claim within 20 days following an accident.
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Time Limit on Certain Defenses: Claims cannot be denied due to material misrepresentation after a specified period.
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Agent Authority: Agents do not have the authority to change policy terms or waive provisions under the Entire Contract provision.
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Noncancelable Policy: Example of a policy that cannot be altered by the insurer up to a stated age, provided premiums are paid.
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Insurance with Other Insurers: If the insurer is unaware of other health coverage prior to a claim, benefits are paid on a pro-rata basis.
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Insuring Clause: Specifies the amount of benefits provided by the health policy.
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Consideration Clause: Outlines premium requirements in an accident and health insurance policy.
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Disability Income Exclusions: Policies typically exclude coverage for disabilities arising from active military duty.
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Grace Period Handling: If a claim occurs during the grace period, the unpaid premium may be deducted from the reimbursement.
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Change of Occupation Provision: If the insured engages in a more hazardous occupation, benefits may be reduced.
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Coverage Termination: Either the insurer or the insured may terminate coverage under a cancelable health insurance policy.
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Benefits Increase: If the insured changes to a less hazardous occupation, benefits can be increased during a covered claim.
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Claim Payment Frequency: Health claim payments must be made at least monthly.
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Legal Action Timing: An insured must wait 60 days after submitting proof of loss before pursuing legal action against the insurer.
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Entire Contract Definition: The policy, endorsements, and attached papers together form the "entire contract" of the insurance agreement.
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Consideration for Policy: The consideration provided by the insured is the first premium payment along with the application.
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Claim Payment Calculation: If an insured submits a claim after the premium due date, the insurer pays the benefit amount minus the overdue premium.
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Other Insurance Provision: This provision protects the insurance company's interests when multiple policies cover the same insured.
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Canceling Policy Steps: An insured must notify the insurer in writing to cancel their health insurance policy.
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Conditionally Renewable Policy: Insurers can refuse renewal based on specific reasons outlined in the contract.
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Description
Test your understanding of key health insurance policy provisions with this quiz. Topics include guaranteed renewable plans, noncancelable policies, and claim notification requirements. Perfect for students or professionals needing a refresher on insurance terms and contract clauses.
