Indiv. Health Ins. Policy Provisions & Medical Plans

Which is NOT among basic medical expense insurance?

• hospital expense insurance

• surgical expense insurance

• physician expense insurance

• nursing home insurance

Under a health insurance contract's consideration clause, which of the following best describes the insurance company's consideration when issuing a health insurance policy?

• The insurance company's consideration is the promise to pay a benefit if the insured continues to pay the premiums.

• The insurance company's consideration is the promise to pay a benefit if a stated future event occurs.

• The insurance company's consideration is the payment of a benefit if the insured suffers a loss.

• The insurance company's consideration is the payment of benefits at the end of the consideration period.

Who or what defines the probationary period used in group insurance?

• The state insurance department defines this period.

• The employee union or collective bargaining group defines this period.

• The insurer sets the period used in the group policy.

• The employer sets the period used in the group policy.

Under a health insurance contract's consideration clause, which of the following best describes the applicant's consideration?

• The applicant's consideration is the first premium he or she pays.

• The applicant's consideration is the application.

• The applicant's consideration is the application and the signed receipt of the delivered policy.

• The applicant's consideration is the application and the first premium he or she pays.

Which of the following optional provisions either allows the insurer to reduce benefits or requires the insurer to reduce the premium rate under certain conditions?

• the entire contract provision

• the other insurance in this insurer provision

• the change of occupation provision

• the other insurance with other insurer provision

The other insurance in this insurer provision in a health insurance policy limits:

• the number of policies a person can own

• the amount of claims an insurer will pay

• the total coverage the insurer provides to a particular insured

• the number of riders in a single policy

When health care services incur a coinsurance payment, the insured must:

• pay costs that exceed the limitation on coverage for the service

• pay half of the cost of each service rendered

• pay the annual deductible amount before the insurer pays a benefit

• find a second health care plan to coordinate payment of the expense.

Which is NOT among the 12 provisions that are required in health insurance policies?

• entire contract

• time limit on certain defenses

• misstatement of age

• proof of loss

Bethany was injured in a car accident. Within how many days must she typically notify her health insurance company about the claim?

• 5

• 7

• 20

• 45

Sarah misstated her age on her health insurance application. The insurer discovers this after receiving notice of Sarah's claim. What result will come from her misstatement?

• The claim will not be paid.

• The claim will be paid, but she must reapply for coverage.

• A penalty will be deducted from the claim payment.

• The benefit payment will be adjusted for her age.