Q.1.
Claim will be paid and coverage will remain in force(Correct.) After a policy has been in force for 2 (sometimes 3) years, it enters the incontestable period, in which the insurer may not deny a claim based on information not disclosed at the time of application.
Q.2.
15("15". Under the Claims Forms provision, an insurer must provide an insured with claim forms within a MAXIMUM of 15 days after receiving notice of a loss.
Q.3.
Entire Contract(Correct.) The Entire Contract provision states that the health insurance policy, together with a copy of the signed application and attached riders and amendments, constitutes the entire contract.
Q.4.
Waiver of Premium rider("Waiver of Premium rider". If a policyowner covered under an accident and health policy wanted to ensure the policy will continue if they ever become totally disabled, they would want to add a waiver of premium rider.
Q.5.
Insuring("Insuring". In an Accident & Health policy, the insuring clause states the amount of benefits to be paid.
Q.6.
review the policy annually and determine whether or not to renew it("review the policy annually and determine whether or not to renew it". With an Optionally Renewable policy, the insurance company may review the policy annually and choose whether or not to renew it.
Q.7.
Payment of Claims(Correct.) The Payment of Claims provision in a Health Insurance policy states to whom claims will be paid.
Q.8.
Prevents delayed claim payments made by the insurer(Correct.) The purpose of the Time of Payment of Claims provision is to prevent the insurance company from delaying claim payments.
Q.9.
The insured(Correct.) In this situation, the insured is liable for the medical bills.
Q.10.
Adjust the premium payments(Correct.) The owner of an Accident and Health policy may not change the premium amount.
Q.11.
45 days(
Q.12.
At the policy's inception(Correct.) The probationary period begins when a policy goes into effect. During this period, no benefits will be paid under the policy.
Q.13.
States the scope and limits of the coverage( "States the scope and limits of the coverage". The purpose of the insuring clause is to specify the scope and limits of the coverage provided.
Q.14.
31(Correct.) The grace period is a minimum of 31 days for policies that are paid for on an annual basis.
Q.15.
After an insured has become totally disabled as defined in the policy("After an insured has become totally disabled as defined in the policy". The waiver of premium provision keeps the coverage in force without premium payments if the insured has become totally disabled as defined in the policy.
Q.16.
Claim will be denied("Claim will be denied". If a person is injured while committing an illegal act, health insurance will not cover the expense of the injury.
Q.17.
Consideration clause(Correct.) A health insurance contract is valid only if the insured provides consideration in the form of the full minimum premium and the statements made in the application.
Q.18.
Exclusions("Exclusions". The exclusions section is NOT included in the policy face (first page of an insurance policy).
Q.19.
Change of occupation provision(Correct.) The change of occupation provision allows an insurer to adjust policy benefits and/or rates if the insured has changed to a more hazardous occupation.