Chapter 16

Question 1

Following a loss, an insured must provide proof of loss to their insurer within how many days?

Answer 1

Within 90 days after a loss or as soon as possible, if incapacitated

Question 2

What is another name for claims form?

Answer 2

Proof of loss forms

Question 3

An insurer generally will not reinstate a policy that has been lapsed for more than _____ years.

Answer 3

3

Question 4

Upon death, any unpaid policy premiums will be deducted from the policy _________.

Answer 4

Benefits

Question 5

How many days does an insurer have to reinstate a lapsed policy?

Answer 5

An insurer has 45 days to decide about reinstating a policy

Question 6

When does the 10-day free look period begin?

Answer 6

On the day the policy is delivered to the policyowner

Question 7

What needs to be provided to an insurer in order to reinstate a lapsed policy?

Answer 7

Reinstatement requires all back premiums, interest, and evidence of insurability

Question 8

What type of policy may be cancelled anytime, for any reason, with proper notification?

Answer 8

A cancelable policy

Question 9

Only the ________ may change the name of the beneficiary.

Answer 9

Policyowner

Question 10

Which clause is a summary of the entire contract and is usually the first or face page of the contract?

Answer 10

The insuring clause

Question 11

A grace period is _______ days and coverage _____ provided during this period.

Answer 11

31; provided

Question 12

If an insured has multiple policies covering the same medical loss, what is the maximum benefit payable by all policies?

Answer 12

Regardless of the number of policies, no more than 100% of the claims (loss) will be paid

Question 13

What renewability provision does not allow for premium increases, policy cancellation, or modifications?

Answer 13

The noncancelable provision

Question 14

What are the different premium payment modes?

Answer 14

Annual, semiannual, quarterly or monthly

Question 15

Being involved in an illegal activity may result in the _________ of a claim.

Answer 15

Denial

Question 16

If two or more family members are injured in a common accident, generally only _____ deductible will apply.

Answer 16

One

Question 17

Define preexisting condition.

Answer 17

A medical condition that was known to exist prior to the policy application

Question 18

For how long may and insurer contest the validity of a claim based on false application information?

Answer 18

For a maximum of 2 years following the issuance of the policy

Question 19

What constitutes the entire contract?

Answer 19

The policy, the application (or copy) and any riders, waivers, or exclusions to the contract

Question 20

All policies sold must conform to the state law in which the policy is ________ and _____________.

Answer 20

Sold; delivered

Question 21

Unless assigned to another party, who is entitled to receive medical benefits?

Answer 21

The insured policy owner

Question 22

What is the name for the period of time following a policy premium due date?

Answer 22

The grace period

Question 23

What renewability provision allows for class based premium increases, but does not allow insurers to cancel contracts?

Answer 23

Guaranteed renewability

Question 24

The least expensive premium mode is ____________, while the most expensive mode is ____________.

Answer 24

Annual; monthly

Question 25

How often may a disability payment be paid?

Answer 25

Not more often than monthly

Question 26

Who pays for the cost of a medical exam?

Answer 26

The insurer

Question 27

What is an owners right?

Answer 27

The right to change premium mode or beneficiary, assign benefits, receive dividends, or borrow from cash value

Question 28

What would constitute proof of loss?

Answer 28

Medical bills, doctor statements, and completed claim forms

Question 29

Claim forms must be provided to an insured within _____ days following the form request.

Answer 29

15

Question 30

An ___________ beneficiary may not be changed without beneficiary permission.

Answer 30

Irrevocable

Question 31

If an insured changes to a less hazardous occupation, his premium could go _______.

Answer 31

Down

Question 32

The __________ is the first beneficiary entitled to receive policy benefits.

Answer 32

Primary

Question 33

An insured must notify her company that she has suffered a loss within ______ days after the loss occurs.

Answer 33

20

Question 34

Medical claims must be paid ___________ upon verification of legitimacy.

Answer 34

Immediately

Question 35

When may an insured being legal action against her insurer?

Answer 35

Between 60 days and 3 years from the denial of a claim.

Question 36

If an insured changes to a more hazardous job and is injured, what recourse does an insurer have?

Answer 36

Changing to a more hazardous job without giving notice allows the insurer to decrease benefits paid

Question 37

The __________ Beneficiary is second in line to receive policy benefits, the ________ is third.

Answer 37

Contingent; tertiary

Question 38

The free look provision may also be called:

Answer 38

The 10-day right to examine

Question 39

Describe coordination of benefits.

Answer 39

When individuals with more than one benefit plan combine their benefits coverage payment without exceeding actual bill