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Questions and Answers
What does a Guaranteed Renewable provision allow?
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?
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?
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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?
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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?
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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?
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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.
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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?
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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?
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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?
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What constitutes the 'entire contract'?
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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?
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Who is protected with the 'other insurance with this insurer' provision?
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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?
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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.
