CH7 Flashcards
An insured submitted a notice of claim to the insurer, but never received claims forms. The insured later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following will be true?
A- The insured must submit proof of loss to the Department of Insurance.
B- The claim most likely will not be paid since the official claims form was not submitted.
C- The insurer will be fined for not providing the claims forms.
D- The insured was in compliance with the policy requirements regarding claims
D- The insured was in compliance with the policy requirements regarding claims
An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?
A- Physical Exam and Autopsy
B- Time of Payment of Claims
C- Legal Actions
D- Incontestability
B- Time of Payment of Claims
When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees
A- Not to change the premium rate for any reason.
B- To charge a lower premium every year the policy is renewed.
C- To renew the policy indefinitely.
D- To renew the policy until the insured has reached age 65
D- To renew the policy until the insured has reached age 65
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain
A- A complete physician’s statement.
B- A statement from the insured’s employer showing that the insured was unable to work.
C- A statement that is sufficiently clear to identify the insured and the nature of the claim.
D- An estimate of the total amount of medical and hospital expensefortheloss.
C- A statement that is sufficiently clear to identify the insured and the nature of the claim.
Which of the following is NOT a feature of a guaranteed renewable provision?
A- The insured’s benefits cannot be reduced.
B- The insured has a unilateral right to renew the policy for the life of the contract.
C- The insurer can increase the policy premium on an individual basis.
D- Coverage is not renewable beyond the insured’sage65.
C- The insurer can increase the policy premium on an individual basis.
Which of the following riders would NOT increase the premium for a policyowner?
A- Impairment rider
B- Waiver of premium rider
C- Multiple indemnity rider
D- Payorbenefitrider
A- Impairment rider
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
A- 7 days
B- 60 days
C- 31days
D- 10days
D- 10days
If more than one family member covered under the same najor medical policy is injured in the same accident, the family only has to pay one deductible. This is due to the
A- Elimination period.
B- Elimination period.
C- Common accident provision.
D- Carry-overprovision.
C- Common accident provision.
A guaranteed renewable health insurance policy allows the
A- Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.
B- Insurer to renew the policy to a specified age.
C- Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term.
D- Policyholder to renew the policy to a stated age and guarantees the premium for thesameperiod.
A- Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.
An insurer would like to add a provision to its individual health insurance policies. This particular provision would be consistent with uniform provisions. Which of the following is TRUE?
A- The provision would be allowed, as long as it is approved by the state.
B- The provision does not require state approval.
C- The state maintains a catalog of additional provisions; any provisions added to policies must be chosen from that pool.
D- Additional provisions are not allowed by state law forhealthpolicies
A- The provision would be allowed, as long as it is approved by the state.
Which health insurance provision describes the insured’s right to cancel coverage?
A- Cancellation provision
B- Insuring clause
C- Policy duration provision
D- Renewalprovision
D- Renewalprovision
Which of the following is true regarding elimination periods and the cost of coverage?
A- The shorter the elimination period, the lower the cost of coverage
B- The longer the elimination period, the higher the cost of coverage
C- The longer the elimination period, the lower the cost of coverage
D- Elimination periods have no effect on the costofcoverage.
C- The longer the elimination period, the lower the cost of coverage
A guaranteed renewable disability insurance policy
A- Cannot be cancelled by the insured before age 65.
B- Is renewable at the insureds option to a specified age.
C- Is renewable at the option of the insurer to a specified age of the insured
D-Is guaranteed to have a level premium for the lifeofthepolicy.
B- Is renewable at the insureds option to a specified age.
