Individual Accident and Health Insurance Policy General Provisions

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

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

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?

Legal actions

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

Payment of claims

What health policy provision allows the insured a period of time to examine the policy and determine whether or not to keep it?

Free-look period

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

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

What health policy renewability provision allows the insurer to terminate coverage for any reason, and to increase the premiums for any class of insureds?

Optionally renewable

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

Notice of claim

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

The insurer

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

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

When can an irrevocable beneficiary be changed?

With the written consent of the beneficiary

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

The insurance company

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

Cancellation

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

Immediately

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

The mode of the premium payment

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

Renewability provision

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

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

Monthly

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

The policy will be cancelled

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

10 days

What health policy provision allows the insurer to nonrenew health coverage if certain events occur?

Conditionally renewable

According to the Time Limit on Certain Defenses provision in health insurance policies, when can an insurer contest fraudulent misstatements on a health insurance application?

Any time while the policy is in force

What renewability provision will most likely appear on a travel accident policy?

Period of time

A policy with a 31-day grace period implies

The policy will not lapse for 31 days if the premium is not paid when due

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is

Monthly

What statement best describes the free look provision?

It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason

Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?

Unlimited

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date?

Optionally renewable

Which of the following statements is correct concerning the changing of an irrevocable beneficiary?

The beneficiary can be changed only with the written consent of that beneficiary

Which of the following provisions requires that any policy language that is in conflict with the state statutes of the state in which the insured resides is automatically amended to conform with those of the state of residence?

Conformity with State Statutes

An insured owes his insurer a premium payment. Since then, he incurs medical expenses. The insurer deducts the unpaid premium amount from the claim amount and pays the insured the difference. What provision allows for this?

Unpaid premium

What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?

As long as the policy is in force

Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insureds?

Optionally renewable

Which is true regarding the Uniform Individual Accident and Sickness Policy Provisions Law?

Provisions may be reworded by the insurer

Which provision concerns the insured’s duty to provide the insurer with reasonable notice in the event of a loss?

Notice of Claim

The insuring clause of a disability policy usually states all of the following EXCEPT

The method of premium payment

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within

90 days of a loss