What is a probationary period in group health insurance?
The period of time that must lapse before an employee is eligible for group health coverage.
What section of a health insurance policy lists the services for which the insurer will not provide coverage?
Exclusions
How will changing one's occupation to be more hazardous affect the health insurance policy in force?
Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation.
What is the name of the act by the insured to voluntarily give up insurance?
Cancellation
What health policy renewability provision allows the insurer to terminate coverage for any reason, and to increase the premiums for any class of insureds?
Optionally Renewable
When an individual is covered under two health plans that have duplicate benefits, the benefit will be prorated to avoid what?
Overinsurance
What is a deductible in an insurance policy?
A specified dollar amount that the insured must pay before the insurer will pay the policy benefits.
What is the purpose of the coinsurance provision in health insurance policies?
To prevent over utilization of the policy benefits.
What health policy provision describes the insured's right to cancel coverage?
Renewal Provision
When can an irrevocable beneficiary be changed?
With the written consent of the beneficiary.
The insured on a health policy misstated his age on the insurance application. If this misrepresentation is discovered, what will happen to the policy?
The benefit amount payable under the policy will be adjusted to the insured's correct age.
What are usual/reasonable and customary charges based on?
Average charge for a given procedure in the specific geographic area.
What will happen to a health insurance policy if the premium has not been paid by the end of the grace period?
The policy will be cancelled.
What health policy provision states to whom the claim benefits must be paid?
Payment of Claims
Who pays the expense for an autopsy under the physical examination and autopsy provision?
The Insurer
What will determine the length of the grace period in a health insurance policy?
The mode of the premium payment.
What health policy provision allows the insurer to not renew health coverage if certain events occur?
Conditionally Renewable
If the insured pays a monthly premium for health insurance, how long would the grace period be on the policy?
10 Days
According to the Time Limit on Certain Defenses provision in health insurance policies, when can an insurer contest fraudulent misstatements on a health insurance application?
Any time while the policy is in force?
According to the Reinstatement provision, once a lapsed policy is reinstated, how soon will coverage be available for accidents?
Immediately
Under an individual disability income policy, the benefits must be paid on at least what schedule?
Monthly
What does the free-look period allow the insured to do?
Return the policy for a full refund of premium within a specified time period, usually 10 days.
What health policy provision allows the insured a period of time to examine the policy and determine whether or not to keep it?
Free-Look Period
What provision provides for the sharing of expenses between the insured and the insurance company?
Coinsurance
What health policy provision defines the insured's duty to provide the insurer with reasonable notice in the event of a loss?
Notice of Claim
What renewability provision will most likely appear on a travel accident policy?
Period of Time
What is the main difference between coinsurance and copay?
Copay is a set dollar amount.
Coinsurance is a percentage of the expenses.
Who decides which optional provisions would be included in a health policy?
The Insurance Company
What health policy provision prevents the insured from bringing a lawsuit against the insurance company for at least 60 days after proof of loss is provided?
Legal Actions
If a health insurance policy has a 31-Day grace period, what does that mean?
The policy remains in effect for 31 days after the premium is due and not paid.