New York Insurance Adjuster License Chapter 4
Terms in this set (30)
What provision describes a responsibility of an insured who is making a claim?
Proof of loss
What is the minimum number of days the grace period must contain in an accident and sickness policy which provides for a weekly premium payment
Under the intoxicants and narcotics provision, the company can deny liability:
TO injuries received by an insured caused by a person under the influence of narcotics not prescribed by a physician
The provision that states the contract owner and the endorsements together form the whole contract between the contract owner and the company is called:
Entire Contract provision
The reinstatement provision in health insurance:
Allows the insured to reinstate the policy after coverage lapses
What is the minimum number of days the grace period must contain in an accident and sickness policy which provides for a weekly premium payment?
A written form submitted to a company by the insured for a loss is known as a:
Proof of loss
If an agent accepts a premium on lapsed disability policy, what would be covered immediately
The time limit on certain defense provisions require that no claim for loss incurred or disability (as defined in the policy) commencing after two years from the date of the policy shall be reduced or denied on the ground that:
A disease of physical condition not excluded from coverage had existed prior to the effective date of the policy.
Which mandated provision assures the policyowner that no existing benefits can be denied or compromised even if the insurer makes changes affecting future policies of like kind or type?
Entire contract provision
If an insured becomes pregnant having family health insurance coverage, the newborn child becomes insured:
immediately at birth
What provision requires the insurance company to pay claims promptly:
Time of payment claim
Jim has a health insurance contract which contains a change of occupation provision. He changes jobs and his new position is in a more hazardous occupation. He neglects to notify the insurance company and two months later, is injured at work. What may the company do?
Reduce the benefits to the premium rate applicable to the new occupation.
All of the following are optional provisions in individual health insurance policies except:
Notice of claim.
How long will coverage remain in effect after the premium due date on an annual premium health insurance policy?
Standards for health insurance policy provisions have been established by the uniform policy provisions law. A required provision concerning "notice of claim" obligates a policyholder to give the insurer or it's agent notice of a claim within:
20 Days of a loss, or as soon as reasonably possible
If an insured dies, when can the beneficiary expect to receive the proceeds
Immediately after the company receives proof of loss
The following statement pertaining to the grace period and reinstatement provisions in health insurance policies is incorrect:
Under a health policy's reinstatement terms, insured losses from accidental injuries and sickness are covered immediately after reinstatement.
Under the misstatement of age provision in a health insurance policy, what can a company do if it discovers that an insured gave a wrong age at the time of application?
Adjust the benefits
The conformity with state statutes provision in a health insurance policy stipulates that any policy provision that is in conflict with the statutes of the state where the insured resides is:
Automatically amended to conform to the minimum requirements of the states statutes
Which section of a health insurance policy specifies the conditions, times, and circumstances under which the insured is not covered by the policy.
What type of health insurance policy prevents the company from changing the premium rate or modifying the coverage in any way?
Under the requirements for newborn infant coverage, health insurance policies which provide coverage for family members must automatically cover a newborn child. If a specific premium or fee is required for each child, the policy may require that in order for the coverage to continue the insurer must be notified and the premium must be paid within:
Individual policies of accident and sickness insurance must provide the policyholder with the right to receive a full refund of premium if the policy is returned within:
10 days of it's delivery
Health insurance coverage becomes available for newborn children:
immediately at birth
If an insured becomes pregnant with only a single health insurance coverage, the newborn child becomes insured:
Immediately at birth
The "free look" provision usually gives a new insured ____ after delivery or receipt of the policy to determine its value
What clause in a health insurance policy states that the insured and insurer share in the covered loss
The time payment of claims provision requires that claims will be paid immediately, or within _______ upon receipt of proof of loss, except for periodic payments.
Insureds cannot sue their insurers for payment under an individual health insurance policy until _______ days after a written proof of loss has been submitted or after _______ years from the date of filing the proof of loss.
60 days, 3 years