Busy. Please wait.
Log in with Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't Know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how


health insurance provisions

Is an insurance company required to return unearned premiums on a policy cancellation? In all cases where the insured has paid for coverage beyond the cancellation date
Matilda goes motocross racing over the Memorial Day weekend and suffers a broken leg. She contacts her agent to purchase a major medical policy and files a claim when the policy is issued. The company declines the claim. The grounds for declination is: The broken leg was a preexisting condition
John has been in the hospital for five days. How long does he have to file a claim form and show proof of loss with his insurance company? 90 days
Which of the following may be an optional provision under the Uniform Provisions Law? Physical Exam Change in occupation Entire Contract Time limit to file claims change in occupation
What provision of a health policy may cover preexisting conditions? entire contract
Joan asked her agent when she will have benefits if she reinstates a lapsed health policy. Her agent would be correct if he told her: Immediately for accidents and 10 days for sickness
Michael was laid off accepted a new position with a substantial reduction in pay. Due to an accident, Michael was disabled. The benefit paid was more than Michael's current salary. What is the company that issued the policy obligated to do? under a relation of earnings to insurance optional provision, pay a reduced benefit based on Michael's current earnings
Co-insurance is designed to control what? Make the insured responsible for some of the charges to hold down claims payments
Which of the following is one of the ownership rights of an insurance contract? Pay a claim Change a beneficiary Consideration provision Insuring provision Change a beneficiary
Fred has purchased a cancellable policy. He should understand that: The insurance company may cancel the policy at any time with proper notice and refund all unearned premium.
A grace period allows a certain number of days by contract for the insured to submit a premium. Except for weekly and monthly premium contracts, what is the usual grace period? 31 days
Old Reliable issues a policy that may not be cancelled by the insurance company, except for non-payment of premium. The company does have the right to adjust premiums for an entire class of business. This type of policy is called: guaranteed renewable
Fred has purchased a health policy with a Waiver of Premium rider. When can Fred expect to receive benefits from this rider? If Fred becomes totally and permanently disabled, the insurance will waive all premiums during the period of disability.
The incontestable clause will provide what protection? After two years, the claim may not be contested by the insurance company except for fraud.
The policy requires her to notify the insurance company if she changes occupations. When the policy was issued, Julia was a bank employee. At the time of disability, she had changed occupations to become a welder. What kind of benefit should she expect? A lower benefit since she had changed to a more hazardous occupation
A company may use a rider or an endorsement to do any of the following EXCEPT: Add benefits Change the insuring clause Increase premiums Restrict benefits change the insuring clause
Zack was involved in a serious accident that required him to be hospitalized. His blood alcohol level was well above the allowable limit. Zack's insurance policy will most likely pay his benefit at what level? Nothing, as alcohol related accidents are usually policy exclusion.
Mr. Jones wants a health policy that can never be cancelled by the insurance company. He also wants one that will guarantee the premiums for the life of the policy (no premium increases). He should look for a policy that is: noncancelable
Normally, proof of loss for a medical claim must be submitted to the insurance company for consideration within 90 days UNLESS: the insured is not of legal capacity
Using the facility of payment clause in a policy, the insurance company may pay an amount up to the maximum limit to: the insured's estate
Martha decides she does not want the new policy she purchased. She is within her free look period, so she returns the policy. She should receive: a full refund of all premiums paid
The application and the premium is which part of the contract? consideration
The grace period for a health insurance policy may vary according to: frequency of premium payments
Mary has been admitted to the hospital for testing. How long does she have to give notice of claim to the insurance company? 20 days
Seth has notified his insurance company that he has a claim. The insurance company must furnish a claim form within how many days to comply with the governing provisions? 15 days
Bill has a policy that will always be the same premium. He has a: noncancelable policy
A pre-existing condition clause protects the insurance company against: adverse selection
A health insurance policy will generally exclude Injuries sustained while falling off a ladder no
A health insurance policy will generally exclude Losses sustained as a result of drug abuse yes
A health insurance policy will generally exclude Hurting oneself intentionally yes
A health insurance policy will generally exclude Injuries incurred while robbing a bank yes
Winston applied for a health ins policy stating that he had never had heart trouble, even though he had suffered a heart attack one year prior to making the application. Winston has a heart attack 2 months after the policy is issued. What will insurer do? The insurance company cancelled the policy and refunded his premiums under Pre-existing condition exclusion
Warren has followed the procedure to initiate a claim for a hospital stay. His insurance company has requested information from him that documents his loss. How long does Warren have to produce this proof of loss? 90 days
The "time limit on certain defenses" provision allows the insurance company to defend against: The time limit for which the insurance company may cancel the policy and refund premiums for material misrepresentation in the application
Nick is reading his policy to determine any exclusions that he should know about. If he suffers a loss as a result of using intoxicants or narcotics, he should expect which of the following from most policies? Losses from the use of intoxicants or narcotics will only be covered if prescribed by a licensed physician
Samantha has not paid her premium on her health insurance policy. It has not lapsed, but the premium is due. On her pending claim, Samantha can expect: The insurance company will pay the claim minus the premium due
Joan was robbing a bank when she was severely injured in a car accident as she tried to make her escape. Joan can expect her health insurance policy to: pay nothing because she was engaged in illegal activity
The legal action provision states that a policyholder must wait for how long after presenting proof of loss before bringing legal action against the insurer? 60 days
The free look period for an insurance policy begins: when the agent delivers the policy
The company will renew the policy to a certain age and never increase premiums is an example of a guaranteed renewable policy
The policy clause that states, "benefits are subject to all the provisions, conditions, and exclusions of the policy" is: insuring clause
The insured and the insurance company are each responsible for a percentage of a medical claim. This feature is called a: co insurance
Which of the following types of policies might have a Guaranteed Insurability Clause attached? Major Medical PPO HMO Disability Income disability income
A policyholder is injured while robbing a home. He has to be hospitalized as a result of his injury. When the insurance company discovers that a felony is involved with the claim, the insurance company may do what? Deny the claim based on no liability
Roland has been on a trip and has failed to pay the premium due on his health insurance policy. His agent explains to him that he still has coverage because his policy has what? a grace period
Regina is insured under a guaranteed renewable health contract. The insurance company may increase rates as follows: Only when an entire class of insured's has a premium increase
What is the time limit for an insured to notify the insurance company of a loss? 20 days
Kathy has a cancellable health policy. Her insurance company may Raise premiums for her class of insured's yes
Kathy has a cancellable health policy. Her insurance company may Cancel the policy with notice yes
Kathy has a cancellable health policy. Her insurance company may Change the state required provisions of the policy no
Kathy has a cancellable health policy. Her insurance company may Give a 30-day notice of cancellation yes
How many mandatory provisions for health insurance contracts are there? 12 mandatory 11 optional
There are two parties mentioned in the insuring clause. Who are they? the insurance company and the insured
Joe has named his wife, Sarah, primary beneficiary to his Accidental Death and Dismemberment Policy. Joe is not able to change the beneficiary without Sarah's consent. This type of arrangement is called irrevocable
An insured has reported the wrong age and the wrong occupation on his application. What is the insurance company allowed to do when the error is discovered? Pay a benefit that the premium paid would have purchased at the correct age or occupation
Created by: 100000819223738
Popular Insurance sets




Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
restart all cards