Health Insurance Policy Provisions Prep

Question 1

What’s the entire contract clause

Answer 1

It assures the policyowners that no changes will be made to the contract or waive any of the provisions after it has been issued

Question 2

Time limit on certain defenses clause?

Answer 2

Limits the time during which the insurance company may challenge the validity of an insurance claim on the basis of a misstatement made on the insureds application….

Question 3

Grace period provision?

Answer 3

It’s in accidental death and dismemberment policies, its to give the policyowners additional time to pay overdue premiums.. 10 days weekly premiums and 31 days to policies payable on annual.

Question 4

Reinstatement provision?

Answer 4

Specified that if an insured fails to pay a renewal premium within the time granted but the insurer subsequently accepts the premium, coverage may be restored…

Question 5

Notice of claim provision

Answer 5

Describes the policyowners publication to notify the insurance company of a claim in a reasonable period of time, typically the period is 20 days after the occurrence

Question 6

Claim forms

Answer 6

It’s the company’s responsibility to supply a claim for to an insured within 15 days after receiving notice of claim, if the company fails to send out claim forms, insured should submit the claim in any form.

Question 7

Proof of loss

Answer 7

The claimant has 90 days in which to submit proof of loss.

Question 8

Time payment of claims

Answer 8

Provides for immediate payment of the claim after the insurer receives notification and proof of loss… the purpose of this shit is to prevent the insurance company from delaying claim payments, also insurer establishes certain conditions insured must meet while claim is pending

Question 9

Payment of claims

Answer 9

Specified how and to whom claim payments are to be made.

Question 10

Physical exam autopsy

Answer 10

Unless it’s forbidden by state law

Question 11

Legal actions

Answer 11

Insured cannot take legal action agains company over claims dispute until after 60 days from the time the insured submits proof of loss

Question 12

Change of beneficiary

Answer 12

Insured can change beneficiary

Question 13

Change of occupation

Answer 13

Reduces maximum benefit payable under the policy of the insured switches to a more hazardous occupation, or to reduce the premium rate charged if the insured changes to a less hazardous job

Question 14

Misstatement of age

Answer 14

The insurer can adjust the benefit to what the premiums paid would have purchased at the insureds actual age

Question 15

Insuring clause

Answer 15

Is to specify the scope and limits of the coverage provided. It’s the part of the health insurance policy that identifies the specific type of health care services that are covered by that policy and the circumstances under which they will be paid

Question 16

Consideration clause

Answer 16

States the amount and frequency of the premium payments

Question 17

Probationary period

Answer 17

Becomes effective at the inception of the policy

Question 18

Cancelable policies

Answer 18

Allows the insurer to cancel or terminate the policy at anytime

Question 19

Optionally renewable policies

Answer 19

Gives the insurer the option to terminate the policy on a date specified in the contract

Question 20

Conditionally renewable policies

Answer 20

Allows an insurer to terminate the coverage but only in the event of one or more conditions stated in the contract (reaching a certain age or loosing employment)

Question 21

Guaranteed renewable policies

Answer 21

Specifies that the policy must be renewed as along as the premiums are being paid, until the insured reaches a specified age (60-65)

Question 22

Noncancelable policies

Answer 22

Cannot be cancelled nor can its premium rates be increased under any circumstances (other than reaching a specific age or no n-payment of premiums) it guarantees premium rates and renewability