Health - Policy Provisions, Riders, and Exclusions

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 insurer was not notified prior to the claim that the insured has other health coverage
C) the policy is beyond the incontestable period
D) the policy is beyond the free-look period

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) decrease the premiums
B) increase the benefit level
C) increase the premiums
D) reduce the benefit level

Which of the following reduces the opportunity for overinsurance?

A) Coordination of benefits provision
B) Conformity with state statutes
C) Insuring clause
D) Reduction in coverage provision

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) the unpaid premium may be subtracted from the reimbursement
C) the claim is paid in full and the unpaid premium will be waived by the insurer
D) no claim will be paid until premium is paid current

Which of the following health insurance provisions requires that the application becomes part of the policy?

A) entire contract clause
B) insuring clause
C) consideration clause
D) application clause

A Guaranteed Renewable provision allows

A) discrimination of individuals who have an increased loss experience
B) premiums which can only be increased per rate class
C) cancellation of the policy at the insurer's discretion
D) premiums that may not be increased beyond contractual requirements

Which health policy clause specifies the amount of benefits to be paid?

A) payment mode
B) free-look
C) insuring
D) consideration

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) premiums cannot be adjusted
B) benefits can be increased in the event of a covered claim
C) benefits will remain the same in the event of a covered claim
D) benefits can be reduced in the event of a covered claim

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

A) purchasing more insurance from this insurer
B) the insurer will pay the claim
C) submitting another claim
D) bringing legal action against the insurer

An insured is covered with a health insurance policy. If the insured would like to cancel the policy, he/she must

A) provide a reason for cancelling
B) wait until the end of the calendar year
C) notify the insurance company by telephone
D) notify the insurance company in writing

Which of the following provisions allows an insured or the insurer to terminate the policy?

A) Cancelable provision
B) Optionally renewable provision
C) Guaranteed renewable provision
D) Conditionally renewable provision

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) any reason the insurer sees fit
C) profitability reasons
D) specific reasons stated in the contract

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) $200
B) $500
C) $300
D) $0

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) guaranteed renewable
C) noncancelable
D) conditionally renewable

Who is protected with the "other insurance with this insurer" provision?

A) insured
B) claimant
C) policyowner
D) insurance company