Chapter Exam – Health Provisions example #29023

Noncancellable (Non-cancellable policies provides guaranteed renewability and premium rates)

notify an insurer of a claim within a specified time (The Notice of Claims Provision spells out the insured's duty to provide the insurer with reasonable notice in the event of a loss.)

Protect the producer (The Legal Actions provision is designed to do all these EXCEPT protect the producer.)

Insuring clause (The insuring clause identifies the specific type of health care services that are covered by that policy)

Monthly ( The time of payment for claims is usually specified in different policies as 60 days, 45 days, or 30 days. However, if the claim involves disability income benefits, the benefits must be paid not less frequently than monthly.

31 ( The grace period is a minimum of 31 days for policies that are paid for on an annual basis)

The insured (In this situation, the insured is liable for the medical bills.)

Entire Contract ( An Entire Contract policy provision prohibits an insurance company from incorporating external documents into an insurance policy. )

Insuring ( In an accident & health policy, the insuring clause states the amount of benefits to be paid )

Payment of claims ( payment of claims is considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions )

Insuring clause ( The insuring clause states the amount of benefits to be paid in an Accident and Health policy )

Premiums normally increase at time of renewal ( A Guaranteed Renewable Health Insurance policy can have increasing premiums at time of renewal )

Immediately ( Under the Time of Payment of Claims provision, the insurer must pay the benefits immediately after receiving proof of loss )

Excluded by the insurer in the contract provisions ( An exclusion is a provision that entirely eliminates coverage for a specified risk, such as an act of war and aviation )

When the state prohibits this by law ( When the state prohibits this by law )

November 1 ( The insured must wait 60 days after written proof of loss before legal action can be brought against the company )

Waiver of premium rider ( If a policy owner covered under an accident and health policy wanted to ensure the policy will continue if they ever become totally disabled, they would want to add a waiver of premium rider )

Time Limit on Certain Defenses ( The provision limits the period during which an insurer can deny a claim based on a misstatement made by the insured )

Change of occupation provision ( The change of occupation provision allows an insurer to adjust policy benefits and/or rates f the insured has changed to a more hazardous occupation )

Claim will be denied ( If a person is injured while committing an illegal act, health insurance will not cover the expense of the injury )