Upgrade to remove ads
Only A$47.99/year
- Social Science
- Business
- Insurance
-
Flashcards
-
Learn
-
Test
-
Match
-
Flashcards
-
Learn
-
Test
-
Match
Terms in this set (17)
Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?
A The insured may carry over the amount of this year's expenses to next year, which will help satisfy next year's
deductible.
B The deductible will be waived.
C The insured is now eligible for an integrated deductible until the new policy year.
D The insured must satisfy this year's deductible, but next year's deductible will begin when or if he makes a claim in the following calendar year.
A The insured may carry over the amount of this year's expenses to next year, which will help satisfy next year's deductible.
Items
stipulated in the contract that the insurer will not provide coverage for are found in the
A Exclusions.
B Insuring clause.
C Benefit Payment clause.
D Consideration clause.
A Exclusions.
The provision that provides for the sharing of expenses between the insured and the insurance company is
A Divided cost.
B Coinsurance.
C Stop-loss.
D Deductible.
B Coinsurance.
When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled?
A The insurer may settle this claim for less than it otherwise would have had the notification been provided in a timely manner.
B The insurer may deny the claim
since it was not notified within the required 20-day time frame.
C The insurer is considered to be notified since the notification to agent equals notification to the insurer.
D The insurer may delay the payment of this claim for up to 6 months.
C The insurer is considered to be notified since the notification to agent equals notification to the insurer.
Which of the following is NOT a feature of a guaranteed renewable provision?
A Coverage is not renewable beyond the insured's age 65.
B The insured's benefits cannot be reduced.
C The insurer can increase the policy premium on an individual basis.
D The insured has a unilateral right to renew the policy for the life of the contract.
C The insurer can increase the policy premium on an individual basis.
The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the
A Incontestability clause.
B Legal action against us clause.
C Entire contract clause.
D Time limit on certain defenses clause.
C Entire contract clause.
A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?
A If the man
is not convicted, he will get 75% of his claim paid.
B The claim is paid in full.
C Claim is denied if his policy contains the Illegal Occupation provision.
D 50% of claim will be paid.
C Claim is denied if his policy contains the Illegal Occupation provision.
Insurers may change which of the following on a guaranteed renewable health insurance policy?
A Individual rates
B No changes are
permitted.
C Rates by class
D Coverage
C Rates by class
An insured misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued?
A Adjust the claim benefit to reflect the insured's true age
B Deny any
claims and cancel the policy
C Deny paying a claim based on misrepresentation
D Pay the full amount of a claim because the contestable period has ended
A Adjust the claim benefit to reflect the insured's true age
Which of the following is true regarding elimination periods and the cost of coverage?
A The longer the elimination period, the higher the cost of coverage
B Elimination periods have no
effect on the cost of coverage.
C The longer the elimination period, the lower the cost of coverage
D The shorter the elimination period, the lower the cost of coverage
C The longer the elimination period, the lower the cost of coverage
Which of the following statements is most correct concerning the changing of an irrevocable beneficiary?
A They may be changed at any time.
B They can never be
changed.
C They may be changed only on the anniversary date of the policy.
D They can be changed only with the written consent of that beneficiary.
D They can be changed only with the written consent of that beneficiary.
An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?
A
Within two years of the application, the insurer discovers a misrepresentation.
B The insured is in an accident and incurs a large claim.
C The insured does not pay the premium.
D The insured reaches the maximum age limit specified in the policy.
B The insured is in an accident and incurs a large claim.
Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes
A Benefit of Payment clause.
B Waiver of Benefit rider.
C Waiver of Premium rider.
D Return of Premium rider.
C Waiver of Premium rider.
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as
A Gatekeepers.
B Usual, customary and reasonable.
C Relative-value schedule.
D Benefit schedule.
B Usual, customary and reasonable.
What statement best describes the free look provision?
A It allows the company to obtain an inspection and medical examination on the proposed insured prior to issuing the policy.
B It allows for
the proposed insured to carefully look over the policy before applying for it.
C It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason.
D It allows the proposed insured to carefully look over the application prior to filling it out.
C It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason.
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day
A Probationary period.
B Waiver of benefits period.
C Elimination period.
D Blackout period.
C Elimination period.
According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT
A The insurer must provide the insured a written notice of the cancellation.
B Claims incurred before cancellation must be honored.
C An insurance company may cancel the policy at any time.
D Unearned premiums are retained by the insurance company.
D Unearned premiums are retained by the insurance company.
Students also viewedOther health insurance concepts
15 terms
ariela_la_maravilla
Disability Income and Related Insurance
15 terms
study_pro96
Health
98 terms
Luttrell5
Missed Questions 3
24 terms
Tommylikethegun92
Other sets by this creatorhealth insurance questions
79 terms
jordan_nichole_opal
Additional L&H questions
118 terms
jordan_nichole_opal
Missed L&H Questions
184 terms
jordan_nichole_opal
life and health Ch. 8
15 terms
jordan_nichole_opal
Other Quizlet setssalma exam 8,9,10
276 terms
salma19772
NAQT-History-YGK-Modern Speeches
48 terms
Lois-LA001
The Tragedy of Julius Caesar, Act III, Scene 1-3 S…
30 terms
AbsoluteMagnitudePlus
Jackson Era Test
12 terms
morgpay