Questions and Answers
How will the insurer handle a claim for a chronic neck problem that was not disclosed at the time of application?
Claim will be paid and coverage will remain in force
In which situation can an autopsy NOT be performed if an individual dies with an accidental death and dismemberment policy?
What is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision?
Periodic health claim payments must be made at least how often?
Signup and view all the answers
What is the clause that identifies which losses resulting from an accident or sickness are insured by the policy?
Signup and view all the answers
A noncancellable disability income policy cannot be canceled or have premiums increased.
Signup and view all the answers
According to the time limit of certain defenses provision, non-fraudulent misstatements first become incontestable after how long?
Signup and view all the answers
What does the legal actions provision of an accident and health policy require?
Signup and view all the answers
What does an assignment of benefits of a health policy do?
Signup and view all the answers
What is the maximum amount of time after the premium due date during which the policy remains in force, even though the premium has not been paid?
Signup and view all the answers
What describes a policy that covers an individual until 65 but allows insurers to change premiums?
Signup and view all the answers
Which policy provision addresses pre-existing conditions?
Signup and view all the answers
Which of the following is included in the policy face?
Signup and view all the answers
What provision specifies that a health policy may be restored after a lapse due to non-payment?
Signup and view all the answers
The entire contract provision states that the application and policy contain all provisions and constitute the entire contract.
Signup and view all the answers
What must the policy owner provide to the insurer to validate that a loss has occurred?
Signup and view all the answers
With a typical short-term medical expense policy, the coverage is nonrenewable.
Signup and view all the answers
The provision that limits coverage in a health policy is called the ______.
Signup and view all the answers
Study Notes
Health Insurance Policy Provisions
- Disability income claim for a chronic neck problem may be paid if over two or three years old due to the incontestable period, even if there was a prior undisclosed health issue.
- Autopsies related to accidental death and dismemberment policies can occur unless state law explicitly prohibits it.
- Autopsies can also be performed when foul play is suspected, the cause of death is unclear, or consent is not given.
- Eligibility for premium waiver requires that the insured is under a doctor's care.
- Periodic health claim payments must be made monthly under individual health policies.
- The insuring clause defines which losses are covered by the policy due to accidents or sickness.
- Noncancellable policies cannot be canceled or have increased premiums by the insurer.
- Non-fraudulent misstatements in health insurance policies become incontestable after two years.
- The insuring clause also specifies the healthcare services provided by the policy.
- The grace period provision allows coverage continuation for up to 31 days after a premium due date.
- The consideration clause outlines conditions not met by applicants when completing insurance applications.
- Guaranteed renewable policies may have premiums that increase upon renewal.
- Legal actions provision requires a 60-day wait post-proof of loss submission before filing a lawsuit.
- Assignment of benefits transfers policy payments to designated parties other than the policyholder.
- Change of occupation provisions allow insurers to adjust coverage if a policyholder changes to a less hazardous job.
- Claim forms must be issued by insurers within 15 days post-notification of loss.
- The entire contract provision confirms that both the application and policy contain all provisions of the agreement.
- Claims related to injuries during illegal acts, such as carjacking, will generally be denied.
- Conditions attached to optional renewability allow the insurer to assess renewability annually.
- Exclusions limit coverage and are not included in the policy face.
- The insured must provide proof of loss to validate claims after an incident.
- Reinstatement provisions apply if a premium is paid post-lapse; coverage may be restored.
- Probationary periods start from the policy's inception and set the timeframe when no benefits are paid.
- Intoxicants and narcotics exclusions lead to the insured being responsible for medical bills incurred during instances like driving under the influence.
- The payment of claims provision indicates to whom benefits will be disbursed.
- The entire contract condition specifies that producers cannot amend policies or waive provisions without authority.
- Owners cannot adjust premium payments but can file claims, assign ownership, or cancel coverage as necessary.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on health insurance policy provisions including claims, coverage eligibility, and specific terms like incontestable periods and autopsy rules. This quiz covers essential aspects of health insurance that every participant should understand. Dive into the world of insurance policy details to enhance your knowledge.
