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Chapter 7

Health Insurance Policy Provisions, Clauses, and Riders

QuestionAnswer
Which of the following is NOT an exclusion in medical expense insurance policies? Coverage for dependents
Which provision concerns the insured’s duty to provide the insurer with reasonable notice in the event of a loss? Notice of Claim
The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the Insuring clause.
Which of the following is NOT a feature of a guaranteed renewable provision? The insurer can increase the policy premium on an individual basis.
While a claim is pending, an insurance company may require An independent examination as often as reasonably required.
In the event a policy lapses due to nonpayment of premium, within how many days would the policy be automatically reinstated once the outstanding premium is paid? 45 days
A Health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective? Immediately
When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees To renew the policy until the insured has reached age 65.
Which of the following is NOT a feature of a noncancellable policy? The insurer may terminate the contract only at renewal for certain conditions.
A guaranteed renewable disability insurance policy Is renewable at the insured's option to a specified age.
The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the Entire contract clause.
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain A statement that is sufficiently clear to identify the insured and the nature of the claim.
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? 10 days
Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is Monthly.
An insured misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The company will do what regarding any claim that has been issued? Adjust the claim benefit to reflect the insured's true age
Which of the following entities has the authority to make changes to an insurance policy? Insurer's executive officer
medical expense policy establishes the amount of benefit paid based upon the prevailing charges which fall within the standard fees normally charged for a specific procedure by a doctor of similar training/experience in that geographic area is known as Usual, customary and reasonable.
The relation of earnings to insurance provision allows the insurance company to limit the insured’s benefits to his/her average income over the last 24 months.
The insuring clause of a disability policy usually states all of the following EXCEPT The method of premium payment.
Which of the following riders would NOT increase the premium for a policyowner? Impairment rider
applicant for an individual health policy failed to complete application properly. Before being able to complete the application/pay the initial premium, she is confined to a hospital. This wont be covered by insurance bc she has not met the Consideration Clause.
Which health insurance provision describes the insured’s right to cancel coverage? Renewal provision
What type of policy allows the insurance company to cancel a policy at any time? Cancellable
Which of the following is true regarding elimination periods and the cost. Of coverage The longer the elimination period, the lower the cost of coverage
Created by: Hayley92
 

 



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