Unit 22 Flashcards
A company may change the wording of a uniform policy provision in its health insurance policies only if the:
(A) company’s board of directors approves the change
(B) modified provision is not less favorable to the insurer
(C) applicant directs that it be changed
(D) modified provision is not less favorable to the insured
(D) modified provision is not less favorable to the insured
The affordable Health Care Act mandates that children of the insured are eligible for health insurance coverage until they attain age:
(A) 20
(B) 21
(C) 22
(D) 26
(D) 26
Which of the following statements pertaining to the grace period and reinstatement provisions in health insurance policies is NOT correct?
(A) Craig’s health policy has a grace period of 31 days. He had a premium due June 15 while he was on vacation. He returned home July 7, mailed his premium the next day and the insurer received it July 10. His policy would have remained in force.
(B) Warren’s medical expense policy was reinstated on September 30 and he became ill and entered the hospital on October 5. his hospital expense will not be paid by the insurer.
(C) Under a health policy’s reinstatement terms, insured losses from accidental injuries and sickness are covered immediately after reinstatement.
(D) States may require grace periods of 7, 10, or 31 days, depending on the mode of premium payment or term of insurance; however, many states require a 31-day grace period in any case.
(C) Under a health policy’s reinstatement terms, insured losses from accidental injuries and sickness are covered immediately after reinstatement.
Which of the following is the usual grace period for a semiannual premium policy?
(A) 7 days
(B) 20 days
(C) 31 days
(D) 60 days
(C) 31 days
Diana, the beneficiary under her husband’s AD&D policy, submits an accidental death claim on May 1, 2010, following his death. However, the company denies the claim on the basis that death was due to natural causes. She decides to talk to her attorney. What is the earliest date for taking legal action against the insurer?
(A) May 2, 2010
(B) June 1, 2010
(C) July 1, 2010
(D) May 1, 2011
(C) July 1, 2010
All of the following are required uniform provisions in individual health insurance policies EXCEPT:
(A) change of occupation
(B) grace period
(C) entire contract
(D) reinstatement
(A) change of occupation
Under the misstatement of age provision in a health insurance policy, what can a company do if it discovers that an insured gave a wrong age at the time of application?
(A) Cancel the policy
(B) Increase the premium
(C) Adjust the benefits
(D) Assess a penalty
(C) Adjust the benefits
The conformity with state statutes provision in a health insurance policy stipulates that any policy provision that is in conflict with the statutes of the state where the insured resides is:
(A) to be submitted to the chief financial officer for approval
(B) cause for the insured’s policy to be voided
(C) automatically amended to conform to the minimum requirements of the state’s statutes
(D) to be rewritten if the policy is returned to the company
(C) automatically amended to conform to the minimum requirements of the state’s statutes
Which section of a health insurance policy specifies the conditions, times, and circumstances under which the ensured is NOT covered by the policy?
(A) Coinsurance provision
(B) Coverages
(C) Insuring clause
(D) Exclusions
(D) Exclusions
Which kind of health insurance policy assures renewability up to a specific age of the insured, although the company reserves the right to change the premium rate on a class basis?
(A) Noncancellable
(B) Guaranteed renewable
(C) Optionally renewable
(D) Cancellable
(B) Guaranteed renewable
According to the notice of claims provision in a health insurance policy, a claimant normally must notify the insurance company of loss within how many days after the loss occurs?
(A) 10
(B) 20
(C) 40
(D) 60
(B) 20
Which of the following types of health insurance policies prevents the company from changing the premium rate or modifying the coverage in any way?
(A) Optionally renewable
(B) Noncancellable
(C) Guaranteed renewable
(D) Cancellable
(B) Noncancellable
