Ch 3 Quiz Flashcards
Which of the following provisions is mandatory for health insurance policies? A recurrent disability B unpaid premiums C intoxicants in narcotics D physical examination and autopsy
D physical examination and autopsy
Physical examination and autopsy is mandatory provision required by law.
With respect to the Consideration Clause, which of the following would be considered consideration on the part of the application for insurance?
A notice of policy cancellation
B payment of premium
C promise to renew the policy at the end of the policy.
D providing warrantees on the application
B payment of premium
The two types of consideration on the part of an insurance applicant are payment of premiums and representations on the application
Which of the following statements is true concerning the alteration of optional policy provisions?
A once any kind of provision is written, it cannot be changed
B an insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder
C an insurer may change the wording of an optional provisions, regardless of its affect on the policyholder
D an insurer may change the wording of optional policy provisions that would adversely affect the policyholder but must first receive state permission before the change goes into effect
B an insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder
Optional policy provisions can be changed by an insurer, as long as it changes do not adversely affect the policyholder
All the following are correct about the required provisions of a health insurance policy EXCEPT
A proof of loss forms must be sent to the insured within 15 days of notice of claim
B a grace period of 31 days is found in an annual pay policy
C the entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract
D a reinstated policy provides immediate coverage for an illness
D a reinstated policy provides immediate coverage for an illness
Accidental injury is covered immediately, but to protect the insurer against adverse selection, losses resulting from sickness are covered only if the sickness occurs at least 10 days after the reinstatement date
Insurers may change which of the following on a guaranteed renewable health insurance policy? A no changes are permitted B rates by class C coverage D individual rates
B rates by class
On a guaranteed renewable health insurance policy, the insurer may increase premiums on a class basis only and not on an individual policy
What is the contract provision that allows the insurer to non-renew Health coverage of certain events occur? A guaranteed renewable B conditionally renewable C optionally renewable D non-cancellable
B conditionally renewable
The conditionally renewable provision is very similar to the optionally renewable provision. The primary difference is that conditionally renewable policies may be canceled for specific conditions contained in the policy, but optionally renewable policies do not specify a conditional reason for cancellation.
An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she's confined to a hospital. This will not be covered by insurance because she has not had this condition specified in the A consideration clause B insuring clause C pre-existing conditions clause D eligibility clause
A consideration clause
The consideration clause specifies that both parties in the contract must get some valuable consideration. The payment of the premium is a consideration given by the applicant. Because the applicant had not paid in initial premium, she is not covered by insurance.
Which of the following entities has the authority to make changes in an insurance policy? A insurers executive officer B Department of insurance C broker D producer
A insurers executive officer
An insured owes his insurer a premium payment. Since then, he incurs medical expenses. But insurer deducts the unpaid premium amount from the claim amount and pays the insured the difference. What provision allows for this? A legal action B proof of loss C payment of claims D unpaid premium
D unpaid premium
If a premium is past due and insured owes claim payment, the amount of the premium will be deducted from the amount of the claim. For example, if a claim is worth $500 and the premium cost $200, the insured would receive the net total of $300 from his insurer.
Items stipulated in the contract that the insurer will not provide coverage for are found in the A benefit payment clause B consideration clause C exclusions D insuring clause
C exclusions
Exclusions are restrictions of coverage as stated in the policy
How soon following the occurrence of a covered loss must insured submit written proof of such loss to the insurance company?
A as soon as possible
B within 20 days
C within 60 days
D within 90 days or as soon as reasonably possible, but not to exceed one year
D within 90 days or as soon as reasonably possible, but not to exceed one year
Which provision states the insurance company must pay medical expense claims immediately? A time of payment of claims B payment of claims C legal actions D relation of earnings to insurance
A time of payment of claims
Renewability provisions are included in each health insurance contract outlines both insurers and insured’s right to cancel or renew coverage. This is considered to be a very important provision required by capital HIPAA, The federal health insurance portability and accountability act of 1996.
Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policy owner? A proof of loss B payment of claims C change beneficiary D entire contract clause
B payment of claims
The payment of claims provision states of the claims must be paid to the policy owner. Unless the death proceeds need to be paid to a beneficiary
In respect to the consideration clause, which of the following is consideration on the part of the insurer?
A promising to pay in accordance with the contract terms
B offering a secondary policy to the application
C offering in unconditional contract
D explain policy revisions to the applicant
A promising to pay in accordance with the contract terms
Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insureds? A guaranteed renewable B optionally renewable C conditionally renewable D cancelable
B optionally renewable
The renewability provision in an optionally renewable policy gives the insurer the option to terminate policy for any reason on the date specified in the contract. Furthermore, this provision allows insurer to increase the premium for any class of optionally renewable insureds.
