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Under a health insurance policy, the provision that states the kind of benefits provided and the circumstances under which they will be paid is called the?
A)payment of claims provision
B)entire contract provision
C) insuring clause
D) benefit clause
Which of the following is NOT a required uniform provision in individual health policies?
A)Change of occupation
B)Legal Actions
C)Notice of claim
D)Reinstatement
The conditions, times, and circumstances under which an insured is NOT covered by a health policy are called?
A)reinstatements
B)deductibles
C)inclusions
D)exclusions
All of the following are included as part of a contract in the entire contract provision EXCEPT the
A) riders
B)application
C)changes made by the producer
D)policy
What amount will be paid under a policy where the insured misstated his/her age?
A)The amount stated in the policy, only if the insured pays an additional premium
B)No adjustments will be made
C)An amount the premium would have purchased at the correct age
D)No amount will be paid because the insured misstated his/her age
A health insurance policy paid on a quarterly basis has a grace period of:
A)7 days
B)10 days
C)31 days
D)60 days
Christine has a health insurance policy that has been in force beyond the incontestable period. The insurer has discovered that a fraudulent statement was made on the application. What would the insurer have to pay on a claim, assuming this wasn't a guaranteed renewable policy?
A)Nothing
B)50% of the claim's amount
C)75% of the claim's amount
D)100% of the claim's amount
The misstatement of age provision in a health policy states that if an insured gives the wrong age at the time of application, what action can the insurance company take?
A)Reissue the policy
B)Policy cancellation
C)Benefits can be adjusted
D)Premiums can be adjusted
In what situation does a waiver of premium provision keep a health insurance policy in force without premium payments?
A)When an insured becomes unemployed
B) When an insured is involved in an accident at work
C)When an insured is confined in a hospital
D)When an insured becomes totally disabled
The insurer has the option of terminating a health insurance policy on a date stated in the contract. What type of policy is this?
A)Optionally renewable
B)Renewable
C)Conditionally renewable
D)Cancellable
Under the Payment of Claims provision, when are benefits typically payable after proof of loss is received?
A) within 60 days
B) Within 30 days
C)Immediately
D)By the end of the calendar year
Which type of health insurance policy cannot be canceled by the insurer nor increase the premiums?
A)Renewable
B)Noncancellable
C)Guaranteed renewable
D)Conditionally renewable
All of the following are functions of an insuring clause EXCEPT
A)States the conditions under which the policy will pay
B)Outlines the kind of benefits provided
C)Primarily describes the free-look period
D)Provides the policy's scope and limits of coverage
Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be
A)cancelable
B)guaranteed renewable
C)conditionally renewable
D)optionally renewable
What type of changes can be made to a guaranteed renewable health insurance policy?
A)The policy's provisions
B)The grace period
C)The premium rates of the policyowner
D)The incontestability period
Which of the following is NOT a common exclusion for a medical expense policy?
A) Physical therapy
B)Act of war
C)On-the-job injury
D)Self inflicted injury
Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit?
A)Stop renewing policy when the insured reaches a specified age
B)Cancel policy if premiums are not paid
C)Increase the premiums on an individual basis
D)Increase the premiums on the basis of an entire classification
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?
A)File a lawsuit
B)Contact the insurer again requesting forms
C)Nothing
D)File written proof of loss
A clause that allows an insurer the right to terminate coverage at any anniversary date is called a(n)
A)conditionally renewability clause
B)optional renewability clause
C)selective renewability clause
D)cancelable clause
