Study sets, textbooks, questions
Upgrade to remove ads
Individual Sickness and Accident Insurance
Terms in this set (54)
An insured has medical insurance coverage through two different providers. She has an accident, who pays?
Each insurer pays a portion of the claim
Under the physical exam and autopsy provision, how many times can the insurer have the insured examined at the insurer's expense, while a claim is pending?
Unlimited number of times
If the insured under a disability policy switches to a more hazardous job and issues a claim, the insurance company will:
Adjust the benefit in accordance with the increased risk
Rose bought 3 policies and the benefits exceed the insurance company's maximum benefit allowed. What will happen?
Pro Rata benefit reduction
What is not correct about the required provisions of a health insurance policy?
A reinstated policy provides immediate coverage for an illness
Which renewability provision allows an insurer to terminate a policy for any reason or increase the premiums for any class of insureds?
An insured misstates her age on a application and the insurer finds out after the incontestability period is over. What happens?
They will adjust the claim benefit to reflect the insured's true age?
What best describes the free look period?
It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason
The provision which prevents the insured from bringing any legal action against the company for at least 60 days after the proof of loss is known as:
Under a mandatory uniform provision notice of claim, the first notice of injury/sickness covered under an accident and health policy must contain:
A statement that is clear to identify the insured and the nature of the claim
The free look provision allows:
The right to return the policy for a full premium refund
While a claim is pending, an insurance company may require:
An independent exam as often as reasonably required
Under an individual disability policy, the minimum schedule of time in which claim payments must be made to the insured is:
What provision would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?
Payment of claims
What provision requires any policy language that it in conflict with state statutes is auto amended to conform with those of the state of residence?
Conformity with state statutes
Which renewability provision are you likely to see on a travel accident policy?
Period of time
A health insurance policy lapses, but is reinstated ASAP. How soon will accident coverage begin?
An insured owes a premium payment, the incurs medical expenses. The insurance company deducts the premium from the benefit and pays out the difference. What provision allows this?
When an insured bought a policy he was a window washer. Now he is a librarian. What will the insurance company do?
Adjust the benefit in accordance with the decreased risk
What entity has the authority to make changes to an insurance policy?
The insurance officer
An insured pays a monthly premium of $100 for health insurance. What is the grace period?
10 days (7 days for weekly premium mode, and 31 for all other types of premium mode)
When an insured bought her disability income policy, she told the agent that she was 30. Her correct age is 37. If the policy has the optional misstatement of age provision, what will the insurance company do?
The amount payable under the policy will reflect the correct age
In respect to the consideration clause, what is the consideration on the part of the insurer?
Promising to pay in accordance with the contract terms
What will vary the length of the grace period in health insurance policies?
The made of premium payments
What allows the policy holder a period of time, while covered, to examine a policy before deciding to keep it?
Free look period
An insured forgets to pay her premium on March 1st and breaks her leg on March 19th. What will happen?
The insurance company will pay the claim because it is during the grace period
An agent proposed an individual health insurance policy that is guaranteed renewable. If the applicant accepts, the insurer agrees that:
The company will renew the policy until the insure is 65 years old
In the event of a loss, who is responsible for providing claim forms to the insured?
Insurer must give them to the insured
What is not a reason to cancel a noncancellable health insurance policy in the insurer's part?
The insured is in an accident and incurs a large claim
What is true of a term health policy?
It is nonrenewable
An insured notofies the insurance company that he is now disabled. What states that claims must be paid immediately upon written proof of the loss?
Time of payment of claims
Under a health insurance policy, benefits, other than death, will be paid to:
What is correct of changing an irrevocable beneficiary?
Must have written consent of irrevocable beneficiary to replace
A man is injured while robbing a bank. What happens to the claim?
It will be denied because of the illegal occupation provision
Under uniform required provisions, proof of loss should be filed within:
Which renewal option does not guarantee renewal and allows the insurance company to refuse renewal of a policy?
What provision is mandatory for health insurance policies?
Physical Examination and autopsy
When an individual is covered by 2 policies that have double indemnity benefits, which makes a claim profitable, it is called:
Insurers may change __________________, on a guaranteed renewable health insurance policy?
Rates by class
What is the contract provision that allows the insurer to nonrenew coverage if certain events occur?
Which provision concerning the insured's duty to provide the insurer with notice in the event of a loss?
Notice of Claim
What is true of the alteration of optional policy provisions?
An insurer may change the working of it does not affect the policy holder
The provision that ensures that the insurer cannot refer to a document not in the contract is:
The Entire Contract Clause
The insuring clause of a DI policy usually does not state:
Method of premium payment
In an optionally renewable policy, the insurer has what option?
A policy with a 31 day grace period implies:
A policy won't lapse for 31 days if the premium isn't paid when due
An insured wants to name her husband as the beneficiary for her health insurance policy, but wants all rights of ownership. What kind of beneficiary should she name him?
Which provision states that the insurance company must pay medical expense claims immediately?
Time of payment of claims
What provision prevents insurance companies from paying a claim to someone other than the policyowner?
Payment of Claims
Linda broke her leg and notified the Agent 12 days after the accident. The agent notified the company 60 days later. How is the claim handled?
The insurer is considered notified when the agent is notified
How soon after an occurrence of a covered loss must written proof be submitted?
Preferably ASAP, 90 days, or at the most 1 year
The expense for an autopsy covered by a physical exam and autopsy provision is paid for by:
What is the maximum period of time that the insurer can contest false health statements on a health insurance application?
For as long as the policy remains in force
Sets with similar terms
Individual health policy general provisions (9)
CH. 16 Health insurance policy provisions
CH7 VA State and Health Exam
Other sets by this creator
Sickness and Accident Basics
Insurance for Senior Citizens & Special needs Indi…
Other Quizlet sets
U. S. History Final
Social Psych Test 1 Study Guide (Lectures 1-7, Cha…
A&P2 Lab FINAL (Kerr- Montgomery)
Mastering Biology Chapter 10: Photosynth…