chapter 16 health insurance policy provision quiz

Question 1

the insuring clause

Answer 1

states the scope and limits of the coverage

Question 2

which of the following is not included in the policy face

Answer 2

exclusions

Question 3

which of the following health insurance policy provisions specifies the health care services a policy will provide

Answer 3

insuring clause

Question 4

x is insured with a disability income policy that provides coverage until age 65. this policy allows the insurer to change the premium rate for the overall risk class assigned. which of these renewability features doe this policy contain

Answer 4

guaranteed renewable

Question 5

what type of renewability guarantees premium rates and renewability

Answer 5

noncancellable

Question 6

with accidental death and dismemberment policies what is the purpose of the grace period?

Answer 6

gives the policyowner additional time to pay overdue premiums

Question 7

with optionally renewable health policies the insurer may

Answer 7

review the policy annually and determine whether or not to renew it

Question 8

when an insurance company sends a policy to the insured with an attached application, the elemnet that makes the application part of the contract between the insured and the insurer is called the

Answer 8

the entire contract provision

Question 9

an insured must notify an insurer of a medical claim within _______ days after an accident

Answer 9

20

Question 10

what must the policyowner provide to the insurer for validation that a loss has occurred

Answer 10

proof of loss

Question 11

which of the following provision specifies how long a policyowners health coverage will remain in effect if the policyowner does not pay the premium when its due

Answer 11

grace period

Question 12

which type of renewability best describes a disability income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class

Answer 12

guaranteed renewable

Question 13

T sends proof of loss to her insurer for an acceptable medical expense claim under her individual health insurance policy. upon receipt the insurer must pay the benefits

Answer 13

immediately

Question 14

what is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision

Answer 14

insurer must be under physician care

must have a doctor certify that you meet the definition of disability as contained on the rider

Question 15

insurers may request a hearing within. ________ if their policy is rejected

Answer 15

20 days

Question 16

P is a major medical policyowner who is hospitalized as a result of injuries sustained from participation in a carjacking. how will the insurer most likely handle this claim

Answer 16

claim will be denied

Question 17

T files a claim on his accident and health policy after being treated for an illness. the insurance company believes that T misrepresented his actual health on the initial insurance application and is therefore disputing the validity of the claim. the provision that limits the time period during which the company may dispute a claims validity is called

Answer 17

time limit on certain defenses

Question 18

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. which policy specifies that coverage may be restored in this situation

Answer 18

reinstatement

Question 19

S filed a written proof of loss for a disability income claim on Sept 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning

Answer 19

november 1 — must wait 60 days after written proof before legal action can be brought against the company

Question 20

the insured and insurance company will share the cost of covered losses under which health policy

Answer 20

payment of claims provision

Question 21

an insured pays premiums on an annual basis for an individual health insurance policy. what is the minimum amount of days for the grace period provision

Answer 21

31

Question 22

the clause in an accident and health policy which defines the benefit amounts the insurer will pay is called the

Answer 22

insuring clause

Question 23

an insurance company normally has 2 years to contest information provided on an accident and health applicaiton. this 2 year period begins on the date that the

Answer 23

insurer dates the policy

Question 24

which of the following statments best describes what the legal actions provision of an accident and health policy requirements

Answer 24

an insured must wait at least 60 days after proof of loss has been submitted before a lawsuit can be filed

Question 25

which of the following health insurance policy provisions specifies the health care services a policy will provide

Answer 25

insuring clause

Question 26

health insurance benefits not covered due to an act of war are

Answer 26

excluded by the insurer in the contract provisions

Question 27

which health policy clause specifies the amount of benefits to be paid

Answer 27

insuring

Question 27

which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy

Answer 27

entire contract

Question 28

an insurer must provide an insured with claim forms within ____ days after receiving notice of loss

Answer 28

15

Question 29

which of the following best describes a short term medical expense policy

Answer 29

nonrenewable

Question 30

what should an insured do if the insurer does not send claims forms within the time period set forth in a health policys claim forms provision

Answer 30

submit the claim in any form

Question 31

the notice of claims provision requires a policyowner to

Answer 31

notify an insurer of a claim within a specified time