HEALTH POLICY PROVISIONS, CLAUSES, AND
RIDERS PRACTICE QUESTIONS
The provision that state that both the printed contract and a copy of the application form
the contract between the policy-owner and the insurer is called the....
a-entire contract
b-certificate of insurance
c-aleatory contract
d-master policy - Answers :entire contract
an insured pays her major medical insurance premium annually on March 1. last March
she forgot to Mail her premium to the company. On March 19, she had an accident and
broke her leg. The insurance company would
a-pay half her claim because the insured had an outstanding premium
b-pay the claim
c-hold the claim as pending until the end of the grace.
d-Deny the claim - Answers :pay the claim
An insured pays a monthly premium of $100 for her insurance. What would be the
duration of the grace period under her policy?
a-7 days
b-10 days
c-31 days
d-60 days - Answers :10 days
What statement best describes the free look provision?
a-It allows the insured to return the policy within 10 days for a full refund of premiums if
dissatisfied for any reason
b-it allows the proposed insured to carefully look over the application prior to filling out
c-it allows the company to obtain an inspection and medical examination on the
proposed insured prior to issuing the policy
d-it allows for the proposed insured to carefully look over the policy before applying for it
- Answers :It allows the insured to return the policy within 10 days for a full refund of
premiums if dissatisfied for any reason
Which provision states that the insurance company must pay medical expense claims
immediately?
a-Legal actions
b-relation of earnings to insurance
c-time of payment of claims
d-payment of claims - Answers :time of payment of claims
, How soon following the occurrence of a covered loss must an insured submit written
proof of such loss to the insurance company?
a-As soon as possible
b-within 20 days
c-within 60 days
d-within 90 days or as soon as reasonably possible, but not to exceed one year -
Answers :within 90 days or as soon as reasonably possible, but not to exceed one year
Which of the following does the insuring clause not specify?
a-The insurance company
b-the name of the insured
c-a list of available doctors
d-covered perils - Answers :a list of available doctors
The selection of a health policy that states the causes of eligible loss under which an
insured is assumed to be disabled is the
a-consideration clause
b-probationary period
c-Insuring clause
d-incontestability clause - Answers :Insuring clause
Which of the following entities has the authority to make changes to an insurance
policy?
a-Producer
b-insurance executive officer
c-Department of Insurance
d-broker - Answers :insurance executive officer
And insured submitted a notice of claim to the insurer, but never received claims forms.
He later submits proof of loss, and explains the nature and extent of loss in a
handwritten letter to the insurer. Which of the following would be true?
a-The claim most likely will not be paid since the official claims form was not submitted
b-teen sure will be fined for not providing the claims forms
c-the insured must submit proof of loss to the Department of Insurance
d-the insured was in compliance with the policy requirements regarding claims -
Answers :the insured was in compliance with the policy requirements regarding claims
When an insured purchased her disability income policy, she misstated her age to the
agent. She told the agent that she was 30 years old , one in fact, she was 37. If the
policy contains the optimal misstatement of age provision
a-the elimination period will be extended six months for each year of age misstatement.
b-Because the misstatement curd more than two years ago, it has no effect
c-amounts payable under the policy or reflect the insured's correct age
d-the contract will be deemed void because of the misstatement of age - Answers
:amounts payable under the policy or reflect the insured's correct age
RIDERS PRACTICE QUESTIONS
The provision that state that both the printed contract and a copy of the application form
the contract between the policy-owner and the insurer is called the....
a-entire contract
b-certificate of insurance
c-aleatory contract
d-master policy - Answers :entire contract
an insured pays her major medical insurance premium annually on March 1. last March
she forgot to Mail her premium to the company. On March 19, she had an accident and
broke her leg. The insurance company would
a-pay half her claim because the insured had an outstanding premium
b-pay the claim
c-hold the claim as pending until the end of the grace.
d-Deny the claim - Answers :pay the claim
An insured pays a monthly premium of $100 for her insurance. What would be the
duration of the grace period under her policy?
a-7 days
b-10 days
c-31 days
d-60 days - Answers :10 days
What statement best describes the free look provision?
a-It allows the insured to return the policy within 10 days for a full refund of premiums if
dissatisfied for any reason
b-it allows the proposed insured to carefully look over the application prior to filling out
c-it allows the company to obtain an inspection and medical examination on the
proposed insured prior to issuing the policy
d-it allows for the proposed insured to carefully look over the policy before applying for it
- Answers :It allows the insured to return the policy within 10 days for a full refund of
premiums if dissatisfied for any reason
Which provision states that the insurance company must pay medical expense claims
immediately?
a-Legal actions
b-relation of earnings to insurance
c-time of payment of claims
d-payment of claims - Answers :time of payment of claims
, How soon following the occurrence of a covered loss must an insured submit written
proof of such loss to the insurance company?
a-As soon as possible
b-within 20 days
c-within 60 days
d-within 90 days or as soon as reasonably possible, but not to exceed one year -
Answers :within 90 days or as soon as reasonably possible, but not to exceed one year
Which of the following does the insuring clause not specify?
a-The insurance company
b-the name of the insured
c-a list of available doctors
d-covered perils - Answers :a list of available doctors
The selection of a health policy that states the causes of eligible loss under which an
insured is assumed to be disabled is the
a-consideration clause
b-probationary period
c-Insuring clause
d-incontestability clause - Answers :Insuring clause
Which of the following entities has the authority to make changes to an insurance
policy?
a-Producer
b-insurance executive officer
c-Department of Insurance
d-broker - Answers :insurance executive officer
And insured submitted a notice of claim to the insurer, but never received claims forms.
He later submits proof of loss, and explains the nature and extent of loss in a
handwritten letter to the insurer. Which of the following would be true?
a-The claim most likely will not be paid since the official claims form was not submitted
b-teen sure will be fined for not providing the claims forms
c-the insured must submit proof of loss to the Department of Insurance
d-the insured was in compliance with the policy requirements regarding claims -
Answers :the insured was in compliance with the policy requirements regarding claims
When an insured purchased her disability income policy, she misstated her age to the
agent. She told the agent that she was 30 years old , one in fact, she was 37. If the
policy contains the optimal misstatement of age provision
a-the elimination period will be extended six months for each year of age misstatement.
b-Because the misstatement curd more than two years ago, it has no effect
c-amounts payable under the policy or reflect the insured's correct age
d-the contract will be deemed void because of the misstatement of age - Answers
:amounts payable under the policy or reflect the insured's correct age
