Policies, Provisions, Clauses and Riders

Question 1

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

Answer 1

Payment of Claims

Question 2

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

Answer 2

To prevent overutilization of the policy benefits

Question 3

According to the Time Limit on Certain Defenses provision in health insurance policies, when can an insurer contest fraudulent misstatements on a health insurance application?

Answer 3

Any time while the policy is in force

Question 4

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

Answer 4

Renewal provision

Question 5

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

Answer 5

10 days

Question 6

What health policy provision describes the insured’s right to cancel coverage?

Answer 6

Renewability provision

Question 7

An insured pays her Major Medical Insurance premium annually on March 1st. Last march she forgot to mail her premium to the company. On March 19th, she had an accident and broke her leg. What would the insurance company do with the claim?

Answer 7

Pay the claim.

Because the policy was still in effect due to the grace period, the claim would still be paid.

Question 8

An insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Why?

Answer 8

Stop-loss limit
A specified dollar amount beyond which the insured no longer participates in the sharing of expenses.

Question 9

The insuring clause of a disability policy usually states all of the following EXCEPT
A) The method of premium payment
B) The identities of the insurance company and the insured
C) That insurance against loss is provided
D) The types of losses covered

Answer 9

A) The method of premium payment

Question 10

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?
A) As soon as possible
B) Within 20 days
C) Within 60 days
D) Within 90 days or as soon as reasonably possible but not to exceed one year

Answer 10

D) Within 90 days or as soon as reasonably possible but not to exceed one year

Question 11

Which of the following riders would NOT increase the premium for a policy owner?
A) Waiver of premium rider
B) Multiple indemnity rider
C) Impairment rider
D) Payor benefit rider

Answer 11

C) Impairment rider

(The impairment rider EXCLUDES specified conditions from coverage, therefore, reducing benefits)