Ch 3 Individual Accident and Health Insurance Policy Provisions

Question 1

Policy pays health policy benefits as a reimbursement of actual expenses

Answer 1

Expense incurred basis

Question 2

A policy that is written on a non-cancelable basis with the right to renew guaranteed

Answer 2

Guaranteed renewable

Question 3

A legal clause in an insurance contract spelling out duties and rights of the insured and the insurer

Answer 3

Provision

Question 4

A formal written law enacted by legislature; insurance _______ can be found in the state insurance code

Answer 4

Statute

Question 5

KT

Insurers must include an individual health insurance policies the standard provision status under NAIC’s uniform individual accident and sickness policy provision

Answer 5

True

Question 6

KT

An insurer is prohibited from making changes to a health insurance policy without an insured’s consent

Answer 6

True

Question 7

KT

A notice of claim and proof of loss are the ________ duties; claims forms in the time of payment of claims are the responsibilities of the ________.

Answer 7

Insured’s / Insurer

Question 8

KT

In response to a misstatement of age on an insurance application, benefits are adjusted per the current premium.

Answer 8

True

Question 9

KT

The ______________ defines the scope of coverage as well as identifies the rights and duties of his party of the contract.

Answer 9

insuring clause

Question 10

KT

Can the insured cancel the insurance policy at any time?

Answer 10

Yes

Question 11

KT

A guaranteed renewable policy requires the issuer to continue coverage, as long as premiums are paid.

Answer 11

True

Question 12

Name the mandatory provisions required in all health insurance policies?

Answer 12

Entire contract, Grace period, Reinstatement, change of beneficiary, claims, legal action…

Question 13

What provision allows the insured a period of time to review the policy and return it for a full refund if dissatisfied?

Answer 13

Free look (or right to examine)

Question 14

What renewability options apply to individual health insurance policies?

Answer 14

Non-cancelable, cancelable, guaranteed renewable

Question 15

What health policy provision allows the insurer to non-renew health coverage if certain events occur?

Answer 15

Conditionally renewable

Question 16

What is the name of the act by the insured to voluntarily give up insurance?

Answer 16

Cancellation

Question 17

What health policy provision describes the insured’s right to cancel coverage?

Answer 17

Renewability provision

Question 18

If the insured pays a monthly premium for health insurance, how long would the grace period be on the policy?

Answer 18

10 days

Question 19

Under an individual disability income policy, the benefits must be paid on at least what schedule?

Answer 19

Monthly

Question 20

What health policy provision allows the insured a period of time to examine the policy and determine whether or not to keep it?

Answer 20

Free look period

Question 21

What health policy provision prevents the insured from bringing a lawsuit against the insurance company for at least 60 days after proof of loss is provided?

Answer 21

Legal actions

Question 22

What health policy provision defines the insured’s duty to provide the insurer with reasonable notice in the event of a loss?

Answer 22

Notice of claim

Question 23

When can an irrevocable beneficiary be change?

Answer 23

With the written consent of the beneficiary

Question 24

What does the free look period allow the insured to do?

Answer 24

Return the policy for a full refund of premium within a specified time period (Usually 10 days)

Question 25

What will determine the length of the grace period in a health insurance policy?

Answer 25

The mode of the premium payment

Question 26

According to the time limit on certain defenses provision on health insurance policies, when can an insurer contest fraudulent misstatements on a health insurance application?

Answer 26

Any time while the policy is in force

Question 27

The insured on a health policy misstated his age on the insurance application. If this misrepresentation is discovered, what will happen to the policy?

Answer 27

The benefit amount payable under the policy will be adjusted to the insured’s correct age.

Question 28

Who pays the expense for an autopsy under the physical examination and autopsy provision?

Answer 28

the insurer

Question 29

Who decides which optional provision would be included in a health policy?

Answer 29

The insurance company

Question 30

What health policy provision states to whom the claim benefits must be paid?

Answer 30

Payment of claims

Question 31

How will changing one’s occupation to be more hazardous affect the health insurance policy in force?

Answer 31

Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation

Question 32

According to the reinstatement provision, once a lapsed policy is reinstated, how soon will coverage be available for accidents?

Answer 32

Immediately

Question 33

If a health insurance policy has a 31 day grace period, what does that mean?

Answer 33

The policy remains in effect for 31 days after the premium is due and not paid

Question 34

What will happen to a health insurance policy if the premium has not been paid by the end of the grace period?

Answer 34

The policy will be canceled

Question 35

What renewability provision will most likely appear on a travel accident policy?

Answer 35

Period of time

Question 36

What health policy renewability provision allows the insurer to terminate coverage for any reason, and to increase the premiums for any class of insureds?

Answer 36

Optionally renewable