Chapter 2 Part 1

When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called

• Pro-rata coverage

• Overinsurance

• Double Indemnity Coverage

• Fraternal Coverage

When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should

• Adjust the benefit in accordance with the decreased risk

• Replace the policy with a new one

• Return any unearned premium

• Increase the premium

The provision that states that both the printed contract and a copy of the application form the contract between the policyowner and the insurer is called the

• Master Policy

• Entire Contract

• Certificate of Insurance

• Aleatory Contract

What statement best describes the free look provision?

• It allows the proposed insured to carefully look over the application prior to filling it out.

• It allows the company to obtain an inspection and medical examination on the proposed insured prior to issuing the policy.

• It allows for the proposed insured to carefully look over the policy before applying for it.

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

In respect to the consideration clause, which of the following is consideration on the part of the insurer?

• Promising to pay in accordance with the contract terms

• Offering a secondary policy to the applicant

• Offering an unconditional contract

• Explaining policy revisions to the applicant

The relation of earnings to insurance provision allows the insurance company to limit the insured’s benefits to his/her average income over the last

• 6 months

• 12 months

• 18 months

• 24 months

An 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 hand-written letter to the insurer. Which of the following would be true?

• The insurer will be fined for not providing the claims forms

• The insured must submit proof of loss to the department of insurance

• The insured was in compliance with the policy requirements regarding claims

• The claim most likely will not be paid since the official claims form was not submitted.

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?

• Within 20 days

• Within 60 days

• Within 90 days or as soon as reasonably possible, not not to exceed 1 year

• As soon as possible

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

• An estimate of the total amount of medical and hospital expense for the loss.

• A complete physician's statement.

• A statement that is sufficiently clear to identify the insured and the nature of the claim

• A statement from the insured's employer showing that the insured was unable to work.

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?

• Proof of loss

• Payment of Claims

• Unpaid Premiums

• Legal Action