Health Insurance Policy Provisions

Question 1

Entire contract provision

Answer 1

The insurance policy represents a contract between the insurer and insured and consists of:
-application
-insurance policy
-riders (endorsements)

Question 2

Grace period is ____ days for weekly premium health policies

Answer 2

7

Question 3

Grace period is __ days for monthly premium health policies

Answer 3

10

Question 4

Grace period is __ days for all other mode premium health policies (annually, semiannually, or quarterly)

Answer 4

31

Question 5

One a health policy is reinstated there is a:

Answer 5

10-day probationary period for sickness coverage. No probationary period for accident coverage

Question 6

Written notice of claim must be given to the health insurer within ____ days after occurrence or commencement of any loss covered by the policy

Answer 6

20

Question 7

Continuance of disability claims must notify insurer and may be required to provide proof once every

Answer 7

6 month

Question 8

Insurers must provide a claim form within ___ days upon the receipt of the insured’s notice of health insurance claim

Answer 8

15

Question 9

Written proof of loss must be provided to the health insurer within ___ days of the date of loss

Answer 9

90

Question 10

Insurers must pay lump sum claims ______ after receiving proof of loss

Answer 10

Immediately

Question 11

No legal action can be brought against health insurer:

Answer 11

-prior to 60 days after filing written proof of loss
-after the expiration of 3 years after proof of loss

Question 12

Uniform (Mandatory) health insurance policy provisions

Answer 12

-entire contract
-Incontestability clause
-grace period
-reinstatement
-notice of claim
-claim forms
-proof of loss
-Time of payment of claims
-payment of claims
-physical exam and autopsy
-legal actions
-change of beneficiary

Question 13

If the insured changes to a more hazardous occupation, the insurer will _______ benefits to whatever the premium would have purchased at the higher risk occupation

Answer 13

Reduce

Question 14

If an insured has more than one policy of a similar type with an insurance company, the insurer can _______ the amount of benefits that will be paid under all contracts

Answer 14

Limit

Question 15

If an insured has coverage with another insurer providing benefits for the same loss, the amount paid by the two insurers will be ________

Answer 15

Prorated

Question 16

Unpaid premium can be deducted from

Answer 16

The benefit payable under the claim

Question 17

The insurer may cancel a health policy at any time by giving the insured ___ days written notice

Answer 17

5

Question 18

If the insurer cancels a health policy, unearned premium will be returned to the insured on a ___ ____ basis

Answer 18

Pro rata

Question 19

Optional health insurance policy provisions

Answer 19

-change of occupation
-misstatement of age
-other insurance with this insurer
-insurance with other insurers
-relation of earnings to insurance
-unpaid premium
-cancellation
-conformity with state statutes
-illegal occupation
-narcotics

Question 20

The most common health insurance free-look period is ____ days

Answer 20

10

Question 21

Long-term care insurance and Medicare supplements have ___-day free-look periods

Answer 21

30

Question 22

The ____ clause states the insurer’s promise to pay under the conditions described in the policy and identifies the type of loss covered by the contract

Answer 22

Insuring

Question 23

_________ is an exchange of value and is a necessary element of a legal contract

Answer 23

Consideration

Question 24

The more favorable the renewability provision is to the insured, the _______ the premium

Answer 24

Higher

Question 25

Five types of renewability provisions from the least expense and least favorable to most expense and most favorable to the insured:

Answer 25

1. Cancelable
2. Optionally renewable
3. Conditionally renewable
4. Guaranteed renewable
5. Non-cancelable

Question 26

Cancelable health policy

Answer 26

The insurer can cancel at any time

Question 27

Optionally renewable health policy

Answer 27

The insurer has the option to renew or not for any reason on a premium due or anniversary date. Premiums may be increased on the policy anniversary for a class of insureds

Question 28

Conditionally renewable health policy

Answer 28

The insurer may terminate coverage but only for reasons not based on the insured’s health such as reaching a certain age. Premiums may be increased on the policy anniversary for a class of insureds

Question 29

Guaranteed renewable health policy

Answer 29

The policy cannot be canceled except for non-payment of premium, and premiums may increase on a renewal date if the insurer has raised premiums for all insured in that coverage classification

Question 30

Non-Cancelable health policy

Answer 30

The insurer cannot cancel coverage (except for non-payment of premium) or raise premiums