WEBCE Prep Exam Health Insurance-EXAM
STUDY GUIDE ACCURATE QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES || 100% GUARANTEED PASS
<BRAND NEW VERSION>
Health insurance
broadly covers many risks, such as the loss of income because of disability, the costs of medical
care and treatment, and the costs of care not covered by government plans.
Long term care
A broad term that includes a wide range of assistance, services, or devices provided over an
extended period. It is designed to medical, personal, social needs in a variety of settings and
locations to enable a person to live as independently as possible.
Managed care providers
provide their insured with health care directly through a network of health care providers
Government plans
In relation to health insurance, a third health insurance option after commercial insurers and
managed care plans. include Medicare, Medicaid, Social Security disability, and workers'
compensation.
Medicare
a federal government program that provides hospital and medical insurance to people age 65
and older.
Medicaid
a state public assistance program (with some federal support) that provides health care benefits
for the poor of any age.
State workers' compensation
,provides benefits to workers who become sick or injured because of a job-related event.
Catastrophic plans
are available to persons who are younger than 30 years and cannot afford any other health
insurance, or who want minimal coverage in exchange for a high deductible and a low premium.
These persons are usually single, low-income individuals whose employers do not offer group
health insurance.
Agent's Report
Includes information about the client that would be useful to the underwriter
Binding Receipt
Guarantees coverage from the time the applicant completes the application (or the insured
completes the medical exam).
Conditional Receipt
The coverage begins on the date of application or the date of a medical exam if required,
whichever is later. The receipt is made on the condition that underwriting determines the
insured is insurable.
Buyer's Guide
A type of disclosure to an insurance applicant that explains the applicant's rights and
responsibilities with regard to the insurance coverage.
Policy Summary
outlines the policy's coverages and benefits.
entire contract provision
A life and health policy provision that states that if any guarantees, promises, exclusions, or
anything else are not included in the policy (or in the application, if made a part of the policy),
then they are not part of the contract
time limit on certain defenses provision
One of the 12 required provisions in a health insurance policy. Largely the same as the
incontestable clause in life insurance. It limits the time an insurer can void a contract or deny a
claim for material misrepresentations on the application. Usually 2 or 3 years.
incontestability provision
,A provision in an insurance policy that states that after a policy has been in force for a set
period, the insurer cannot contest a claim for any reason except for non-payment of premiums.
Under most policies, that period is two years.
Grace Period Provision
Coverage remains in effect for 31 days past premium due date; benefits paid during would be
deducted from sum.
Reinstatement Provision
A provision that lets the policyowner place a lapsed policy back in force within a certain period.
This period is typically three years.
physical examination and autopsy provision
One of the 12 required provisions in a health insurance policy. Allows the insurer to require the
insured to take a physical exam during the claims investigation process. (The insurer must pay
for the exam.) If the claim is because of the death of the insured, this provision also allows the
insurer to order an autopsy to determine the cause of death. Again, the insurer must pay for the
autopsy
legal actions provision
One of the 12 required provisions in a health insurance policy. Defines the periods during which
the insured can take against the insurer because it didn't pay a claim.
irrevocable beneficiary
A beneficiary designation in a life insurance policy that the policyowner cannot change without
the beneficiary's written consent.
Notice of Claim provision
the insured must give written notice to the insurer within 20 days after a covered loss occurs
Claim Forms Provision
One of the 12 required provisions in a health insurance policy. States that the insurer must
provide for the insured within 15 days of receiving a notice of claim.
Proof of Loss provision
Policy owner has 90 days from date of loss to submit proof to Insurer; valid claim must be paid
immediately upon receipt.
time payment of claim provision
, One of the 12 required provisions in a health insurance policy. States that the insurance
company pays claims immediately after receiving proper proof of loss. Ongoing income
payments for disability claims must be paid at least monthly.
Change of Occupation Provision
One of the 11 optional provisions in a health insurance policy. This provision allows the insurer
to increase the premium if the insured changes to a more hazardous occupation.
other insurance in this insurer provision
One of the 11 optional provisions in a health insurance policy. This provision limits the total
coverage that the company assumes with one insured. Prevents over insurance
other insurance with other insurers provision
One of the 11 optional provisions in a health insurance policy. Similar to the other insurance in
this insurer provision. But this provision extends to coverage with multiple insurers of which the
primary insurer had prior knowledge
Relation of Earnings to Insurance provision
applies to disability income insurance policies. It avoids overinsurance by reducing the policy's
benefit amount if the disabled insured receives more income from the insurance benefit than
from working.
unpaid premium provision
One of the 11 optional provisions in a health insurance policy. This provision addresses any
premiums the insured may not have paid at the time of a claim. In such a case, the insurer can
deduct this amount from the total benefit it owes the insured.
The cancellation provision
lets an insurer cancel the policy at any time with 45 days' notice. The 45-day notice is also
necessary if the insurer is not going to renew the policy or changes the premium.
Conformity with State Statutes Provision
One of the 11 optional provisions in a health insurance policy. This provision addresses any
provisions that differ from state law. Such a provision is automatically changed to meet the
minimum requirements of the law.
illegal occupation provision
STUDY GUIDE ACCURATE QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES || 100% GUARANTEED PASS
<BRAND NEW VERSION>
Health insurance
broadly covers many risks, such as the loss of income because of disability, the costs of medical
care and treatment, and the costs of care not covered by government plans.
Long term care
A broad term that includes a wide range of assistance, services, or devices provided over an
extended period. It is designed to medical, personal, social needs in a variety of settings and
locations to enable a person to live as independently as possible.
Managed care providers
provide their insured with health care directly through a network of health care providers
Government plans
In relation to health insurance, a third health insurance option after commercial insurers and
managed care plans. include Medicare, Medicaid, Social Security disability, and workers'
compensation.
Medicare
a federal government program that provides hospital and medical insurance to people age 65
and older.
Medicaid
a state public assistance program (with some federal support) that provides health care benefits
for the poor of any age.
State workers' compensation
,provides benefits to workers who become sick or injured because of a job-related event.
Catastrophic plans
are available to persons who are younger than 30 years and cannot afford any other health
insurance, or who want minimal coverage in exchange for a high deductible and a low premium.
These persons are usually single, low-income individuals whose employers do not offer group
health insurance.
Agent's Report
Includes information about the client that would be useful to the underwriter
Binding Receipt
Guarantees coverage from the time the applicant completes the application (or the insured
completes the medical exam).
Conditional Receipt
The coverage begins on the date of application or the date of a medical exam if required,
whichever is later. The receipt is made on the condition that underwriting determines the
insured is insurable.
Buyer's Guide
A type of disclosure to an insurance applicant that explains the applicant's rights and
responsibilities with regard to the insurance coverage.
Policy Summary
outlines the policy's coverages and benefits.
entire contract provision
A life and health policy provision that states that if any guarantees, promises, exclusions, or
anything else are not included in the policy (or in the application, if made a part of the policy),
then they are not part of the contract
time limit on certain defenses provision
One of the 12 required provisions in a health insurance policy. Largely the same as the
incontestable clause in life insurance. It limits the time an insurer can void a contract or deny a
claim for material misrepresentations on the application. Usually 2 or 3 years.
incontestability provision
,A provision in an insurance policy that states that after a policy has been in force for a set
period, the insurer cannot contest a claim for any reason except for non-payment of premiums.
Under most policies, that period is two years.
Grace Period Provision
Coverage remains in effect for 31 days past premium due date; benefits paid during would be
deducted from sum.
Reinstatement Provision
A provision that lets the policyowner place a lapsed policy back in force within a certain period.
This period is typically three years.
physical examination and autopsy provision
One of the 12 required provisions in a health insurance policy. Allows the insurer to require the
insured to take a physical exam during the claims investigation process. (The insurer must pay
for the exam.) If the claim is because of the death of the insured, this provision also allows the
insurer to order an autopsy to determine the cause of death. Again, the insurer must pay for the
autopsy
legal actions provision
One of the 12 required provisions in a health insurance policy. Defines the periods during which
the insured can take against the insurer because it didn't pay a claim.
irrevocable beneficiary
A beneficiary designation in a life insurance policy that the policyowner cannot change without
the beneficiary's written consent.
Notice of Claim provision
the insured must give written notice to the insurer within 20 days after a covered loss occurs
Claim Forms Provision
One of the 12 required provisions in a health insurance policy. States that the insurer must
provide for the insured within 15 days of receiving a notice of claim.
Proof of Loss provision
Policy owner has 90 days from date of loss to submit proof to Insurer; valid claim must be paid
immediately upon receipt.
time payment of claim provision
, One of the 12 required provisions in a health insurance policy. States that the insurance
company pays claims immediately after receiving proper proof of loss. Ongoing income
payments for disability claims must be paid at least monthly.
Change of Occupation Provision
One of the 11 optional provisions in a health insurance policy. This provision allows the insurer
to increase the premium if the insured changes to a more hazardous occupation.
other insurance in this insurer provision
One of the 11 optional provisions in a health insurance policy. This provision limits the total
coverage that the company assumes with one insured. Prevents over insurance
other insurance with other insurers provision
One of the 11 optional provisions in a health insurance policy. Similar to the other insurance in
this insurer provision. But this provision extends to coverage with multiple insurers of which the
primary insurer had prior knowledge
Relation of Earnings to Insurance provision
applies to disability income insurance policies. It avoids overinsurance by reducing the policy's
benefit amount if the disabled insured receives more income from the insurance benefit than
from working.
unpaid premium provision
One of the 11 optional provisions in a health insurance policy. This provision addresses any
premiums the insured may not have paid at the time of a claim. In such a case, the insurer can
deduct this amount from the total benefit it owes the insured.
The cancellation provision
lets an insurer cancel the policy at any time with 45 days' notice. The 45-day notice is also
necessary if the insurer is not going to renew the policy or changes the premium.
Conformity with State Statutes Provision
One of the 11 optional provisions in a health insurance policy. This provision addresses any
provisions that differ from state law. Such a provision is automatically changed to meet the
minimum requirements of the law.
illegal occupation provision
