Wrong Answers Flashcards
(123 cards)
A ______ ______ is the signed document that starts the free-look period.
delivery receipt
The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as
twisting
M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?
Determined by the terms of the policy
Under a basic hospital/surgical expense policy, the amount of the patient’s claim payment will be based on the terms of the policy.
Common accident deductible
A common accident deductible provision states that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied.
A characteristic of Preferred Provider Organizations (PPOs) would be:
Under Preferred Provider Organizations, patient fees are discounted in return for using listed providers.
HRA
HRA plans are employer-funded medical reimbursement plans.
Insurance policies are considered aleatory contracts because
performance is conditioned upon a future occurrence
Insurance contracts are aleatory. This means there is an element of chance and potential for unequal exchange of value or consideration for both parties. An aleatory contract is conditioned upon the occurrence of an event.
Generally, how long is a benefit period for a Major Medical Expense Plan?
One year
A Health Reimbursement Arrangement MUST be established:
HRAs are employer-established benefit plans that must be funded by the employer.
Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?
Correct. In this situation, $10,000 x 20% coinsurance + $100 deductible = $2,100.
A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will:
The correct answer is “continue coverage but exclude the heart condition.” If the insured did not cite the condition on the application and the insurer did not exclude the condition, the pre-existing condition provision still applies. Exclusions are subject to the “time limit on certain defenses” provision, however.
A contract where one party either accepts or rejects the terms of a contract written by another party is called a contract of
A contract of adhesion is a contract offered intact to one party by another under circumstances requiring the second party to accept or reject the contract in total without having the opportunity to bargain over the wording. Insurance policies are contracts of adhesion and, as such, are construed strictly against the party writing them (i.e., the insurer).
What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?
The correct answer is “Waiver of Premium rider”. If a policyowner 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.
Which of the following is NOT included in the policy face?
The exclusions section is NOT included in the policy face (first page of an insurance policy).
The clause in an Accident and Health policy which defines the benefit amounts the insurer will pay is called the:
The Insuring clause states the amount of benefits to be paid in an Accident and Health policy.
Under an individual Health Insurance policy, the Time Limit of Certain Defenses provision states that nonfraudulent misstatements first become incontestable two years
Under the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, nonfraudulent misstatements first become incontestable two years from the date of the policy was issued.
Long Term Care policies will usually pay for eligible benefits using which of the following methods?
Most long-term care policies pay on a reimbursement (or expense-incurred) basis, up to the policy limits.
When does a Probationary Period provision become effective in a health insurance contract?
The probationary period begins when a policy goes into effect. During this period, no benefits will be paid under the policy.
Insurance policies are offered on a “take it or leave it” basis, which make them:
Contracts of Adhesion
A Disability Income policy that only the policyowner can terminate and which the rates will never go up is considered to be
A Disability Income Policy that only the policyowner can terminate and on which the rates will never increase is a Noncancellable policy.
An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses?
Loss of eyesight due to an accidental injury
Loss of the spleen due to an accidental injury
Partial paralysis due to a stroke
Loss of life due to a heart attack
Loss of eyesight due to an accidental injury
A life insurance policy would be considered a wagering contract WITHOUT:
insurable interest
When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans?
Group plans where employees pay a portion of the premiums are called contributory plans.
Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a Disability Income policy?
Issue the policy with a rating
Decline the applicant
Issue the policy with an altered Time of Payment of Claims provision
Issue the policy with a diabetes exclusion
he insurance company may take all of these actions EXCEPT issue the policy with an altered Time of Payment of Claims provision.