Podcast
Questions and Answers
Health insurance benefits NOT covered due to an act of war are?
Health insurance benefits NOT covered due to an act of war are?
Excluded by the insurer in the contract provisions
Which of the following statements describes what an Accident and Health policyowner may NOT do?
Which of the following statements describes what an Accident and Health policyowner may NOT do?
What is the purpose of the insuring clause in Health and Accident policies?
What is the purpose of the insuring clause in Health and Accident policies?
States the scope and limits of the coverage
If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all situations EXCEPT?
If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all situations EXCEPT?
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How many days from the reinstatement application date does the insurance company have to notify M of the denial?
How many days from the reinstatement application date does the insurance company have to notify M of the denial?
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With Optionally Renewable Health policies, what may the insurer do?
With Optionally Renewable Health policies, what may the insurer do?
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What does the Legal Actions provision of an Accident and Health policy require?
What does the Legal Actions provision of an Accident and Health policy require?
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What does the Waiver of Premium provision in an Accident and Health policy state?
What does the Waiver of Premium provision in an Accident and Health policy state?
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Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate?
Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate?
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An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
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Which Accident and Health policy provision addresses preexisting conditions?
Which Accident and Health policy provision addresses preexisting conditions?
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What is the purpose of the Grace Period in Accidental Death and Dismemberment policies?
What is the purpose of the Grace Period in Accidental Death and Dismemberment policies?
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Which of these is considered a mandatory provision in health insurance?
Which of these is considered a mandatory provision in health insurance?
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When does a Probationary Period provision become effective in a health insurance contract?
When does a Probationary Period provision become effective in a health insurance contract?
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What is the purpose of the Time of Payment of Claims provision?
What is the purpose of the Time of Payment of Claims provision?
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How will an insurer handle a Disability Income claim with undisclosed preexisting conditions after a certain period?
How will an insurer handle a Disability Income claim with undisclosed preexisting conditions after a certain period?
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How will the insurer most likely handle a claim involving injuries from participating in a carjacking?
How will the insurer most likely handle a claim involving injuries from participating in a carjacking?
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Which health policy clause specifies the amount of benefits to be paid?
Which health policy clause specifies the amount of benefits to be paid?
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In health insurance policies, what does a waiver of premium provision do?
In health insurance policies, what does a waiver of premium provision do?
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What provision allows an insurer to adjust policy benefits and rates if the insured changes to a more hazardous occupation?
What provision allows an insurer to adjust policy benefits and rates if the insured changes to a more hazardous occupation?
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Which clause details the conditions conditions not met when an insurance application is incomplete?
Which clause details the conditions conditions not met when an insurance application is incomplete?
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What is the MINIMUM number of days for the Grace Period provision for an annual premium payment?
What is the MINIMUM number of days for the Grace Period provision for an annual premium payment?
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Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy?
Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy?
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The provision that defines to whom the insurer will pay benefits is called?
The provision that defines to whom the insurer will pay benefits is called?
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What is the purpose of the Time of Payment of Claims provision?
What is the purpose of the Time of Payment of Claims provision?
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How will an insurer handle a claim for an undisclosed neck injury that resulted in total disability?
How will an insurer handle a claim for an undisclosed neck injury that resulted in total disability?
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Who is responsible for paying medical bills if injuries are sustained due to intoxicated driving?
Who is responsible for paying medical bills if injuries are sustained due to intoxicated driving?
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Which of the following is NOT included in the policy face?
Which of the following is NOT included in the policy face?
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What type of rider would be added to ensure an Accident and Health policy will continue if totally disabled?
What type of rider would be added to ensure an Accident and Health policy will continue if totally disabled?
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Study Notes
Health Insurance Policy Provisions
- Benefits not covered due to acts of war are exclusions outlined in contracts.
- Policyowners of Accident and Health insurance cannot adjust premium payments.
- Insuring clause defines the coverage's scope and limits in Accident and Health policies.
- Autopsies can be performed unless prohibited by state law in cases of accidental death.
- Insurers must notify applicants of a reinstatement denial within 45 days.
- Optionally Renewable policies allow insurers to review and decide on renewals annually.
- The Legal Actions provision requires a 60-day wait after Proof of Loss submission before lawsuits.
- The Waiver of Premium provision waives premium payments after total disability for a specified period.
- Guaranteed Renewable policies can adjust premium rates and are valid until the insured reaches age 65.
- Insurers must provide claim forms within 15 days of receiving notice of a loss.
- Time Limit on Certain Defenses limits insurance companies' denial abilities based on preexisting conditions.
- Grace Period provides policyholders extra time to pay overdue premiums.
- Payment of Claims is a mandatory provision directing where claim benefits are allocated.
- The Probationary Period starts at the policy's inception, during which no benefits are payable.
- Time of Payment of Claims aims to prevent insurance companies from delaying payments.
- The Incontestable Period, after usually 2 or 3 years, protects claims based on undisclosed conditions.
- Illegal acts, such as injury during a carjacking, lead to claim denial.
- The Insuring clause specifies the benefit amounts in health policy contracts.
- Waiver of premium keeps coverage in effect without payments after total disability occurs.
- Change of occupation provision allows insurers to adjust benefits or rates if the insured changes to a riskier occupation.
- Consideration clause requires full minimum premium payment and truthful application completion.
- Minimum grace period for annual premiums is 31 days.
- Entire Contract provision ensures the application and any amendments are part of the health insurance contract.
- Payment of Claims provision defines who will receive benefits from claims.
- Exclusions are not included in the policy face (the first page of the policy).
- A Waiver of Premium rider can be added to ensure coverage continuity in total disability situations.
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Description
Test your knowledge on the specific provisions of health insurance policies with this 10-question quiz. Learn about exclusions and the rights of policyowners in various scenarios. Perfect for students or professionals looking to refresh their understanding of health insurance.
