Health Insurance Policy Provisions Quiz
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Questions and Answers

Which policy provision specifies that coverage may be restored if a renewal premium is paid late?

  • Change of Occupation Provision
  • Grace Period
  • Time Limit on Certain Defenses
  • Reinstatement (correct)

    • Which disability policy provision allows an insurer to adjust policy benefits and rates when an insured changes to a more hazardous occupation?

  • Reinstatement
  • Change of Occupation Provision (correct)
  • Grace Period
  • Payment of Claims

    • What is the policy provision that entitles the insurer to establish conditions that the insured must meet while a claim is pending?

    Time Limit on Certain Defenses

    How many days from the reinstatement application date does the insurer have to notify the insured of denial?

    <p>45 days</p> Signup and view all the answers

    Which provision specifies how long a policyowner's health coverage will remain in effect if the premium is not paid?

    <p>Grace Period</p> Signup and view all the answers

    How will the insurer most likely handle a claim for injuries sustained from participating in a carjacking?

    <p>Claim will be denied</p> Signup and view all the answers

    In which situation is an autopsy not allowed for an Accidental Death and Dismemberment policy?

    <p>When the state prohibits this by law</p> Signup and view all the answers

    What should an insured do if the insurer does not send claim forms within the specified time?

    <p>Submit the claim in any form</p> Signup and view all the answers

    What does the Insuring clause in Health and Accident policies describe?

    <p>States the scope and limits of the coverage</p> Signup and view all the answers

    What is the provision that defines to whom the insurer will pay benefits?

    <p>Payment of Claims</p> Signup and view all the answers

    Which of these is considered a mandatory provision?

    <p>Payment of Claims</p> Signup and view all the answers

    What Best describes a short-term medical expense policy?

    <p>Nonrenewable</p> Signup and view all the answers

    When does a Probationary Period provision become effective in a health insurance contract?

    <p>At the policy's inception</p> Signup and view all the answers

    What is the clause in an Accident and Health policy that defines the benefit amounts the insurer will pay?

    <p>Insuring clause</p> Signup and view all the answers

    Which health policy clause ensures that an insurance company must attach a copy of the application to the policy?

    <p>Entire Contract</p> Signup and view all the answers

    What describes the Waiver of Premium provision in an Accident and Health policy?

    <p>Premiums are waived after the insured has been totally disabled for a specified time period</p> Signup and view all the answers

    What is considered a characteristic of a Conditionally Renewable Health Insurance policy?

    <p>Premiums may increase at time of renewal</p> Signup and view all the answers

    What must the policyowner provide to the insurer to validate that a loss has occurred?

    <p>Proof of Loss</p> Signup and view all the answers

    What will the insurance company do if the policyholder's age was understated at the time of application?

    <p>The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age</p> Signup and view all the answers

    What provision limits the time period during which the company may dispute a claim's validity?

    <p>Time Limit on Certain Defenses</p> Signup and view all the answers

    What must an insured do before filing a lawsuit according to the Legal Actions provision?

    <p>Wait at least 60 days after Proof of Loss has been submitted</p> Signup and view all the answers

    When can S file legal action against the insurer after submitting Proof of Loss?

    <p>November 1</p> Signup and view all the answers

    Which statement about a Guaranteed Renewable Health Insurance policy is CORRECT?

    <p>Premiums normally increase at time of renewal</p> Signup and view all the answers

    If an insurance company issues a noncancellable Disability Income policy, what does this mean?

    <p>The policy cannot be canceled nor can premiums be increased</p> Signup and view all the answers

    What happens with Optionally Renewable Health policies?

    <p>The insurer may review the policy annually and determine whether or not to renew it</p> Signup and view all the answers

    Which health insurance policy provision specifies the healthcare services a policy will provide?

    <p>Insuring clause</p> Signup and view all the answers

    How will the insurer handle a claim for a chronic neck problem not disclosed at the time of application?

    <p>Claim will be paid and coverage will remain in force</p> Signup and view all the answers

    What may an Accident and Health policyowner NOT do?

    <p>Change the premium payments</p> Signup and view all the answers

    When does a waiver of premium provision keep the coverage in force?

    <p>After an insured has become totally disabled as defined in the policy</p> Signup and view all the answers

    What does the Notice of Claims provision require from a policyowner?

    <p>Notify an insurer of a claim within a specified time</p> Signup and view all the answers

    What is the purpose of the Grace Period in Accidental Death and Dismemberment policies?

    <p>Gives the policyowner additional time to pay past due premiums</p> Signup and view all the answers

    What is the purpose of the Time of Payment of Claims provision?

    <p>Prevents delayed claim payments made by the insurer</p> Signup and view all the answers

    What must an insured do if the insurer does not furnish forms after a notice of loss?

    <p>File written proof of loss</p> Signup and view all the answers

    Which Accident and Health policy provision addresses preexisting conditions?

    <p>Time Limit on Certain Defenses</p> Signup and view all the answers

    What type of renewability guarantees premium rates and renewability?

    <p>Guaranteed renewable</p> Signup and view all the answers

    What type of health insurance benefits are excluded by the insurer due to an act of war?

    <p>Excluded by the insurer in the contract provisions</p> Signup and view all the answers

    Who is responsible for paying the medical bills if the insured was driving while intoxicated?

    <p>The insured</p> Signup and view all the answers

    What is the minimum number of days for the Grace Period provision in health insurance policies?

    <p>31</p> Signup and view all the answers

    According to the Time Payment of Claims provision, how frequently must the insurer pay Disability Income benefits?

    <p>Monthly</p> Signup and view all the answers

    Which clause details the conditions that an applicant may not have met if they did not complete all medical history questions?

    <p>Consideration clause</p> Signup and view all the answers

    Study Notes

    Health Insurance Policy Provisions

    • Reinstatement: Coverage may be restored if a lapsed policy's renewal premium is accepted by the insurer after the due date.

    • Change of Occupation Provision: Allows insurers to adjust policy benefits and rates if an insured changes to a more hazardous occupation.

    • Time Limit on Certain Defenses: Entitles the insurer to set conditions that an insured must satisfy while a claim is pending.

    • Notification Period for Reinstatement Denials: Insurers must notify applicants of denial within 45 days of a reinstatement application to avoid automatic reinstatement.

    • Grace Period: Specifies how long coverage remains effective following a premium due date if the premium is unpaid.

    • Claims Denial for Illegal Actions: Claims resulting from illegal activities, like carjacking, will likely be denied by insurers.

    • Autopsy Provisions: An autopsy can be performed in an Accidental Death and Dismemberment policy except when prohibited by state law.

    • Claims Forms Provision: If forms are not sent within the stipulated period, the insured can submit claims in any form.

    • Insuring Clause Purpose: Defines the scope, conditions, and limits of health and accident policy coverage.

    • Payment of Claims: Details to whom benefits will be paid, and is considered a mandatory provision in health insurance policies.

    • Short-term Medical Expense Policy: These policies are nonrenewable, providing temporary coverage.

    • Probationary Period: This provision is effective from the policy's inception, outlining a waiting period for specific coverage eligibility.

    • Insuring Clause for Benefit Amounts: Defines the specific amounts the insurer will pay under an Accident and Health policy.

    • Entire Contract Provision: Requires the inclusion of the application with the insurance policy, making it part of the contract.

    • Waiver of Premium: Premiums are waived after the insured has been totally disabled for a specified duration.

    • Conditionally Renewable Policy Characteristics: Policies may have premiums that increase upon renewal.

    • Proof of Loss: The policyowner must provide validation to the insurer that a loss has occurred to trigger benefits.

    • Adjustment of Benefits Due to Understated Age: If an insured's age is misstated, the insurer will adjust benefits according to what premiums would have purchased at the correct age.

    • Time Limit on Defenses: Limits the timeframe within which the insurer can dispute the validity of a claim.

    • Legal Actions Provision: Requires that an insured must wait at least 60 days after submitting Proof of Loss before initiating legal action.

    • Legal Actions Timeline: Insureds can take legal action against insurers beginning 60 days from submitting Proof of Loss if no response is received.

    • Guaranteed Renewable Health Insurance: Premiums typically increase at renewal, ensuring continuous coverage.

    • Noncancellable Policy: A type of disability income policy that cannot be canceled or subjected to increased premiums by the insurer.

    • Optionally Renewable Policy: Allows insurers to review and decide on policy renewal annually.

    • Insuring Clause for Health Services: Specifies the health care services that a policy will cover.

    • Chronic Conditions Disclosure: Claims related to undisclosed pre-existing conditions may still be covered if the insurer is unaware prior to claim submission.

    • Accident and Health Policy Limitations: Insureds cannot adjust premium payments after policy issuance.

    • Waiver of Premium and Disability: Keeps coverage active without premium payments if the insured has become totally disabled.

    • Notice of Claims Requirement: Policyholders must notify the insurer of claims within a specified timeframe.

    • Grace Period Function: Provides additional time for policyowners to pay overdue premiums without losing coverage.

    • Time of Payment Provision: Ensures timely payment of claims by the insurer, typically requiring at least monthly disbursements for disability benefits.

    • Consideration Clause Importance: Details the conditions not met by applicants, explaining their lack of coverage following application submission without comprehensive medical history.

    • Minimum Grace Period Duration: The minimum grace period for health insurance policies is 31 days.

    • Claims Payment Frequency: Disability Income benefits must be paid at least monthly, as mandated by the Time Payment of Claims provision.

    • Exclusions Due to War: Contracts exclude coverage for health benefits related to acts of war.

    • Responsibility for Medical Bills: Insureds involved in accidents while intoxicated are responsible for their medical bills as per their policy exclusions.

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    Description

    Test your knowledge on the essential provisions of health insurance policies. This quiz covers various aspects such as reinstatement, change of occupation provisions, and claims denial conditions. Challenge yourself and see how well you understand these vital policy features.

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