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29 Cards in this Set
- Front
- Back
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Which health insurance provision describes the insured’s right to cancel? |
Renewal Provision |
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What section of a health insurance policy lists the services for which the insurer will not provide coverage? |
Exclusions |
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Under an individual disability income policy, the benefits must be paid on at least what schedule? |
Monthly |
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Who decides which optional provisions would be included in a health policy? |
The insurance company |
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Who pays free expense for an autopsy under the physical exam and autopsy provision? |
The insurer |
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What is the purpose of the coinsurance provision in health insurance policies? |
To prevent over-utilization of the policy benefits |
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According to the Time Limit on Certain Defenses provision, when can an insurer contest fraud on an application? |
Any time as long as the policy is in force |
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When can an irrevocable beneficiary be changed? |
When the beneficiary gives written consent |
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What is the main difference between coinsurance and copay? |
Copay is a set dollar amount Coinsurance is a percentage |
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What will determine the length of the grace period in a policy? |
The mode (frequency) of the premium payment |
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What is the probationary period in group health insurance? |
The period of time that must lapse before an employee is eligible for group coverage |
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The insured misstated his age on his application. What will happen to the policy if discovered? |
The benefit amount payable will be adjusted to correspond with the correct age |
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What will happen to the policy if the premium has not been paid by the end of the grace period? |
It will be cancelled |
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What provision prevents the insured from bringing a lawsuit against the insurer for at least 60 days after proof of loss is provided? |
Legal actions |
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If a health insurance policy has a 31-day grace period, what does that mean? |
The policy remains in effect for 31 days after the premium is due and not paid |
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What provision allows the insured a period of time to examine the policy and determine whether to keep it or not? |
Free-look period |
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What is the name of the act by the insured to voluntarily give up insurance? |
Cancellation |
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What provision states to whom the claim benefits must be paid? |
Payment of claims |
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What provision defines the insured’s duty to provide the insurer with reasonable notice in the event of a loss? |
Notice of claim |
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What provision provides for the sharing of expenses between the insured and the insurer? |
Coinsurance |
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After the elimination period, a totally disabled insured qualifies for benefits from a policy that has a waiver of premium rider. What will happen to the premium paid into the policy during the elimination period? |
It will be refunded |
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A waiver of premium provision may be included with what type of health insurance policies? |
Disability income |
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According to the Reinstatement Provision, once a lapsed policy is reinstated, how soon will coverage be available for accidents? |
Immediately |
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What is a deductible? |
A specified dollar amount the insured must pay before receiving benefits |
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What does the free-look period allow? |
Return a policy for a full refund of premium within a specified time period (usually 10 days) |
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What provision describes the insured’s right to cancel coverage? |
Renewability Provision |
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What are usual/reasonable and customary changes based on? |
Average charge for a given procedure in the specific geographic area |
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How will changing one’s occupation to be more hazardous affect the Heath insurance policy in force? |
Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation. More hazards = less benefits |
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If the insured pays a monthly premium for health insurance, how long would the grace period be on the policy? |
10 days |
