Policy Provisions, Clauses, and Riders

Question 1

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

Answer 1

Cancellation

Question 2

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

Answer 2

Monthly

Question 3

What health policy provision defines the insured’s duty to provide the insurer with reasonable notice in the event of a loss?

Answer 3

Notice of claim

Question 4

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

Answer 4

10 days

Question 5

What is the main difference between coinsurance and copay?

Answer 5

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

Question 6

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

Answer 6

Exclusions

Question 7

Who decides which optional provisions would be included in a health policy?

Answer 7

The insurance company

Question 8

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

Answer 8

The benefit amount payable under the policy will be adjusted to the insured’s correct age

Question 9

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

Answer 9

Payments of claim

Question 10

After the elimination period, a totally disabled insured qualified for benefits from a disability 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 10

Premium will be refunded

Question 11

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

Answer 11

The mode of the premium payment

Question 12

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

Answer 12

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

Question 13

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

Answer 13

Renewability provision

Question 14

When can an irrevocable beneficiary be changed?

Answer 14

With the written consent of the beneficiary

Question 15

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

Answer 15

To prevent overutilization of the policy benefits

Question 16

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

Answer 16

Free-look period

Question 17

What is a deductible in a health insurance policy?

Answer 17

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

Question 18

Who pays the expense for an autopsy under the physical examination and autopsy provision?

Answer 18

The insurer

Question 19

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

Answer 19

Immediately

Question 20

What is a probationary period in group health insurance?

Answer 20

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

Question 21

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

Answer 21

Disability income

Question 22

What does the free-look period allow the insured to do?

Answer 22

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

Question 23

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 23

Any time while the policy is in force

Question 24

What are the usual/reasonable and customary charges based on?

Answer 24

Average charge for a given procedure in the specific geographic area

Question 25

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

Answer 25

Renewal provision

Question 26

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 26

Legal actions

Question 27

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

Answer 27

Coinsurance

Question 28

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

Answer 28

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

Question 29

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

Answer 29

The policy will be canceled