Chapter 3 / Policy Provisions, Clauses, And Riders Flashcards
According to the time limit on certain defenses provision and health insurance policies, when can insurer contest fraudulent misstatements on a health insurance application?
Anytime while the policy is in force.
Which health insurance provision describes the insured right to cancel coverage?
Renewal provision
If a health insurance policy has a 31 day grace period, what does that mean?
The policy remains an effect for 31 days after the premium is due and not paid.
What are the usual/reasonable customary changes based on?
Average charge for a given procedure in a specific geographic area.
Who pays the expense for an autopsy under the physicians examination and autopsy provision.
The insurer.
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?
Legal actions.
What provision provides for the sharing of expenses between insured and the insurance company?
Coinsurance
What health policy provision allows the insured a period of time to examine the policy and determine whether to keep it?
Free-look period
If the insured pays a monthly premium for insurance, how long would the grace period be on the policy?
10 days.
How will changing one’s occupation to be more hazardous affect the health insurance policy in force?
Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation.
After the elimination period, a totally disabled insured qualified for benefits from a disability income policy that has a waiver of premium rider. What will happen to the premium that was paid into the policy during the elimination period?
Premium will be refunded.
What is a probationary period in group health insurance?
The period of time that must lapse before a employee is eligible for group health coverage.
What is a deductible and a health insurance policy?
A specified dollar amount that the insured must pay before the insurer will pay the policy benefits.
What does free look period allow the insured to do.
Return the policy for a full refund of premium within a specified time (usually 10 days)
What is the purpose of the coinsurance provision and health insurance policies?
To prevent overutilization of the policy benefits.
What health policy provision describes the insureds right to cancel coverage?
Renewability provision.
What will determine the length of the grace period and health a insurance policy?
The mode of the premium payment.
What can an irrevocable beneficiary be changed?
With the written consent of the beneficiary.
What health policy provision states to whom the claim benefits must be paid?
Payment of claims.
A waiver of premium provision may be included with what type of health health insurance policy?
Disability income.
Who decides which optional provision would be included in the health of policy?
Insurance company.
The insured on a health policy misstated his gate on the insurance app. If this misrepresentation is discovered what will happen to the policy?
The benefit amount payable under policy will be adjusted to the insureds correct age.
According to the reinstatement provision, once a lapsed policy is reinstated, how soon will coverage be available for accidents?
Immediately.
What section of a health insurance policy lists the services for which the insurer will not provide coverage?
Exclusions.
What is the name of the act by the insured to voluntarily give up insurance?
Cancellation
What health policy provision defines the insureds duty to provide the insurer with reasonable notice in an event of a loss?
Notice of claim
What will happen to a health insurance policy if the premium has not been paid by the end of the grace period?
The policy will be cancelled
Under an individual disability income policy, the benefits must be paid on at least what schedule?
Monthly
What is the main difference between coinsurance and copay?
Copay is a set dollar amount; coinsurance is a percentage of the expenses
