Chapter 3 / Policy Provisions, Clauses, And Riders

Question 1

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

Answer 1

Anytime while the policy is in force.

Question 2

Which health insurance provision describes the insured right to cancel coverage?

Answer 2

Renewal provision

Question 3

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

Answer 3

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

Question 4

What are the usual/reasonable customary changes based on?

Answer 4

Average charge for a given procedure in a specific geographic area.

Question 5

Who pays the expense for an autopsy under the physicians examination and autopsy provision.

Answer 5

The insurer.

Question 6

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 6

Legal actions.

Question 7

What provision provides for the sharing of expenses between insured and the insurance company?

Answer 7

Coinsurance

Question 8

What health policy provision allows the insured a period of time to examine the policy and determine whether to keep it?

Answer 8

Free-look period

Question 9

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

Answer 9

10 days.

Question 10

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

Answer 10

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

Question 11

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?

Answer 11

Premium will be refunded.

Question 12

What is a probationary period in group health insurance?

Answer 12

The period of time that must lapse before a employee is eligible for group health coverage.

Question 13

What is a deductible and a health insurance policy?

Answer 13

A specified dollar amount that the insured must pay before the insurer will pay the policy benefits.

Question 14

What does free look period allow the insured to do.

Answer 14

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

Question 15

What is the purpose of the coinsurance provision and health insurance policies?

Answer 15

To prevent overutilization of the policy benefits.

Question 16

What health policy provision describes the insureds right to cancel coverage?

Answer 16

Renewability provision.

Question 17

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

Answer 17

The mode of the premium payment.

Question 18

What can an irrevocable beneficiary be changed?

Answer 18

With the written consent of the beneficiary.

Question 19

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

Answer 19

Payment of claims.

Question 20

A waiver of premium provision may be included with what type of health health insurance policy?

Answer 20

Disability income.

Question 21

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

Answer 21

Insurance company.

Question 22

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

Answer 22

The benefit amount payable under policy will be adjusted to the insureds correct age.

Question 23

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

Answer 23

Immediately.

Question 24

What section of a health insurance policy lists the services for which the insurer will not provide coverage?

Answer 24

Exclusions.

Question 25

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

Answer 25

Cancellation

Question 26

What health policy provision defines the insureds duty to provide the insurer with reasonable notice in an event of a loss?

Answer 26

Notice of claim

Question 27

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

Answer 27

The policy will be cancelled

Question 28

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

Answer 28

Monthly

Question 29

What is the main difference between coinsurance and copay?

Answer 29

Copay is a set dollar amount; coinsurance is a percentage of the expenses