Health Policy Provisions, Clauses, & Riders

Front 1

What does the free-look period allow the insured to do?

Back 1

Return the policy for a full refund of premium within a specified time period (usually 10 days)

Front 2

Who decides what optional provisions would be included in a health policy?

Back 2

The insurance company

Front 3

Under an individual disability income policy, the benefits must be paid on at least what schedule?

Back 3

Monthly

Front 4

What will happen to a health insurance policy if the premium has not been paid by the end of the grace period?

Back 4

The policy will be canceled

Front 5

What provision provides for the sharing of expenses between the insured and the insurance company?

Back 5

Coinsurance

Front 6

After the elimination period, a totally disabled insured qualified for benefits from a disability income policy that has a waiver of premium rider. What will happen to the premium that was paid into the policy during the elimination period?

Back 6

Premium will be refunded

Front 7

What health policy provision defines the insured’s duty to provide the insured with reasonable notice in the event of a loss?

Back 7

Notice of claim

Front 8

How will changing one’s occupation to be more hazardous affect the health insurance policy in force?

Back 8

Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation

Front 9

What health policy provision allows the insured a period of time to examine the policy and determine whether to keep it?

Back 9

Free-look period

Front 10

What health policy provision describes the insured’s right to cancel coverage?

Back 10

Renewability provision

Front 11

What section of a health insurance policy list the services for which the insurer will not provide coverage?

Back 11

Exclusions

Front 12

A waiver of premium provision may be included with what type of health insurance policies?

Back 12

Disability income

Front 13

According to the reinstatement provision, once a lapsed policy is reinstated, how soon will the coverage be available for accidents?

Back 13

Immediately

Front 14

When can an irrevocable beneficiary be changed?

Back 14

With the written consent of the beneficiary

Front 15

What is the purpose of the coinsurance provision in health insurance policies?

Back 15

To prevent overutilization of the policy benefits

Front 16

What is a probationary period in group health insurance?

Back 16

The period of time that must lapse before an employee is eligible for group health coverage

Front 17

What is the main difference between coinsurance and co-pay?

Back 17

Co-pay is a set dollar amount; coinsurance is a percentage of the expenses

Front 18

What is a deductible in health insurance policy?

Back 18

A specified dollar amount that the insured must pay before the insurer will pay the policy benefits

Front 19

If a health insurance policy has a 31-day grace period, what does that mean?

Back 19

The policy remains in effect for 31 days after the premium is due and not paid

Front 20

If the insured pays a monthly premium for health insurance, how long would the grace period be for the policy?

Back 20

10 days

Front 21

Which health insurance provision describes the insured’s right to cancel coverage?

Back 21

Renewal provision

Front 22

What is the name of the act by the insured to voluntarily give up insurance?

Back 22

Cancellation

Front 23

What health policy provision states to whom the claim benefits must be paid?

Back 23

Payment of claims provision

Front 24

According to the time limit on certain defenses provision in health insurance policies,when can an insurer contest fraudulent missstatements on a health insurance application?

Back 24

Anytime while the policy is in force

Front 25

What health policy provision prevents the insured from bringing a lawsuit against the insurance company for at least 60 days after proof of loss is provided?

Back 25

Legal actions

Front 26

The insured on a health policy misstated his age on the insurance application. If this misrepresentation is discovered, what will happen to the policy?

Back 26

The benefit amount payable under the policy will be adjusted to the insured’s correct age.

Front 27

What will determine the length of the grace period in a health insurance policy?

Back 27

The mode of premium payment

Front 28

Who pays the expense for an autopsy under the physical examination and autopsy provision?

Back 28

The insurer

Front 29

What are usually/reasonable and customary charges based on?

Back 29

Average charge for a given procedure in a specific geographic area

Front 30

Who decides which optional provisions would be included in a health policy?

Back 30

The insurance company