Chapter 2 Part 2

Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to

• Beneficiary of the death benefit

• The spouse of the insured

• The insured

• Creditors

An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?

• Revocable

• Primary

• Contingent

• Irrevocable

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, when in fact, she was 37. If the policy contains the optional misstatement of age provision

• Because the misstatement occurred more than 2 years ago, it has no effect.

• Amounts payable under the policy will reflect the insured's correct age

• The contract will be deemed void because of the misstatement of age.

• The elimination period will be extended 6 months for each year of age misstatement.

Which of the following is NOT a feature of a guaranteed renewable provision?

• The insured has a unilateral right to renew the policy for the life of the contract.

• Coverage is not renewable beyond the insured's age 65

• The insured's benefits cannot be reduced

• The insurer can increase the policy premium on an individual basis.

Insurers may change which of the following on a guaranteed renewable health insurance policy?

• Coverage

• Individual rates

• No changes are permitted

• Rates by class

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

• 60 days of a loss

• 90 days of a loss

• 20 days of a loss

• 15 days of a loss

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?

• Payment of claims

• Change of beneficiary

• Entire contract clause

• Proof of loss

An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?

• The insured is in an accident and incurs a large claim

• The insured does not pay the premium.

• The insured reaches the maximum age limit specified in the policy.

• Within two years of the application, the insurer discovers a misrepresentation.

In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?

• Insurer to the insured

• Insured to the insurer

• Insurer to the department of insurance

• Insured to the department of insurance

A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

• 50% of the claim will be paid

• If the man is not convicted, he will get 75% of the claim paid

• The claim is paid in full

• Claim is denied if his policy contains the illegal occupation provision.