Benefits under a health insurance policy may with the insureds written request be payable to

An accident and health insurer has just received written proof of loss from one of its insureds. The insured must now wait 60 days before
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a. submitting another claim
b. bringing legal action against the insurer
c. the insurer will pay the claim
d. purchasing more insurance from this insurer
bringing legal action against the insurer
The insured's consideration given for a health insurance policy is
a. the first premium payment and the application
b. the initial premium payment only
c. the application
d. the initial premium and an investigative report
the first premium payment and the application
An accident and health insurance policy's premium requirements are set forth in which of the following provisions?
a. insurance clause
b. entire contract clause
c. consideration clause
d. premium mode

consideration clause
Which of the following statements accurately describes the "time limit on certain defenses"?
a. after a stated period of time, claims cannot be denied due to material misrepresentation of the application
b. all claims can be disputed after two years
c. an insured cannot file a lawsuit within 90 days of the claim being filed
d. the right to return an accident and health policy must be within 10 days of policy delivery

after a stated period of time, claims cannot be denied due to material misrepresentation of the application
Who may terminate coverage under a cancelable health insurance policy?
a. the insured only
b. the insurer only
c. the insurer or the insured
d. an officer of the insurer
the insurer or the insured
An insured files for an accident and health insurance policy claim eight days after the premium due date. The benefit payable is $500 and the overdue premium is $200. Assuming that the policy pays on a first-dollar basis and contains the unpaid premium provision, how much will the insurer pay?

a. $0
b. $200
c. $300
d. $500
$300
The Change of Occupation provision in a Disability Income policy states that, in the event the insured changes to a less hazardous occupation, which of the following may apply?
a. benefits will remain the same in the event of a covered claim
b. premiums cannot be adjusted
c. benefits can be increased in the event of a covered claim
d. benefits can be reduced in the event of a covered claim
benefits can be increased in the event of a covered claim
Tim is covered by an accident and health insurance policy that may not be changed in any way by the insurer up to a stated age, as long as the premiums are paid. What type of policy is this?
a. occupationally renewable
b. noncancelable
c. guaranteed renewable
d. conditionally renewable
noncancelable
An insured is covered with a health insurance policy. If the insured would like to cancel the policy, he/she must
a. wait until the end of the calendar year
b. notify the insurance company in writing
c. notify the insurance company by telephone
d. provide a reason for cancelling
notify the insurance company in writing
Which health policy clause specifies the amount of benefits to be paid?
a. insuring
b. consideration
c. free-look
d. payment mode
insuring
An insured must notify an insurer of a medical claim within how many days after an accident?
a. 10
b. 20
c. 30
d. 40
20
Omar is covered by a disability income policy. He is hurt performing an occupation more hazardous than the occupation listed in his policy. The policy's change of occupation provision will have what effect?
a. increase the benefit level
b. reduce the benefit level
c. increase the premiums
d. decrease the premiums
reduce the benefit level
A Guaranteed Renewable provision allows
a. discrimination of individuals who have an increased loss experience
b. premiums that may not be increased beyond contractual requirements
c. premiums which can only be increased per rate class
d. cancellation of the policy at the insurer's discretion
premiums which can only be increased per rate class
James is covered with health insurance by two different insurers. The "insurance with other insurers" provision in an individual health insurance policy allows an insurer to pay benefits to the insured on a pro-rata basis when
a. the policy's maximum lifetime benefit level has been paid
b. the policy is beyond the incontestable period
c. the insurer was not notified prior to the claim that the insured has other health coverage
d. the policy is beyond the free-look period
the insurer was not notified prior to the claim that the insured has other health coverage
Which statement concerning the Entire Contract provision in an individual accident and health insurance policy is TRUE?
a. the agent can waiver policy provisions and change the policy with the insurer's consent
b. the agent has the authority to waive the policy's provisions under certain conditions
c. the agent has the authority to change the policy under certain conditions
d. the agent doesn't have the authority to change the policy or waive its provisions
the agent doesn't have the authority to change the policy or waive its provisions
Disability income insurance normally excludes coverage for disabilities that arise from
a. automobile accidents
b. injuries sustained while traveling abroad
c. occupational injuries
d. active military duty
active military duty
Which of the following health insurance provisions requires that the application becomes part of the policy?
a. consideration clause
b. insuring clause
c. entire contract clause
d. application clause
entire contract clause
How is an insured's accident and health claim handled by an insurer if it occurs during the policy's grace period?
a. the claim has to be approved by an officer of the insurer
b. no claim will be paid until premium is paid current
c. the claim is paid in full and the unpaid premium will be waived by the insurer
d. the unpaid premium may be subtracted from the reimbursement
the unpaid premium may be subtracted from the reimbursement
Who is protected with the "other insurance with this insurer" provision?
a. insurance company
b. insured
c. policyowner
d. claimant
insurance company
Which of the following health insurance plans charges a premium that cannot be increased?
a. guaranteed renewable
b. cancelable
c. noncancelable
d. conditionally renewable
noncancelable
A health insurance MUST provide a proof of loss form

a. within 10 days of the actual loss
b. within 10 days of receipt of the notice of loss
c. within 15 days of receipt of the notice of loss
d. within 15 days of the actual loss
within 15 days of receipt of the notice of loss
Under what circumstance does an accident and health insurer have the right to request an autopsy?
a. when the claim exceeds an amount specified in the policy
b. when 2 days have passed after death
c. when not prohibited by state law
d. when consent is given by the beneficiary
when not prohibited by state law
Kelly purchases a health insurance policy issued on a conditionally renewable basis. The insurance company has a right to refuse renewal of the policy for
a. any change in Kelly's health
b. specific reasons stated in the contract
c. any reason the insurer sees fit
d. profitability reasons
specific reasons stated in the contract
The standard provisions of an accident and health insurance policy require that the
a. policy, endorsements, and attached papers constitute the "entire contract"
b. policy summary, conditional receipt, and initial premium constitute the "entire contract"
c. change of occupation provision is mandatory
d. grace period be no shorter than 60 days
policy, endorsements, and attached papers constitute the "entire contract"
Periodic health claim payments MUST be made at least
a. monthly
b. weekly
c. daily
d. annually
monthly

What is a benefit of health insurance quizlet?

A type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly.

What provision states that claims must be paid immediately upon written proof of loss?

B. Time of Payment of Claims *The Time Payment of Claims provision requires that claims will be paid immediately upon receipt of proofs of loss except for periodic payments, which are to be paid as specified in the policy.

Which type of policy pays benefits to a policyholder?

Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy? When benefits are paid to a policyowner covered under a Hospital Expense policy, the policy is known as reimbursement.

Which of the following is a reimbursement of benefits for the treatment?

Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party? Subrogation is the right for an insurer to pursue a third party that caused an insurance loss to the insured.

Benefits under a health insurance policy may with the insureds written request be payable to

What is a benefit of health insurance quizlet?

What provision states that claims must be paid immediately upon written proof of loss?

Which type of policy pays benefits to a policyholder?

Which of the following is a reimbursement of benefits for the treatment?

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