EXAMFX - Exam FX Insurance Health Policy Provisions Questions and Answers

Question 1

An insured with a health policy that is paid on a quarterly basis forgets to pay the premium. Ten days after the due date, the insured has an accident and files a claim. How will the insurance company likely handle this claim?

Accepted Answer

Pay the claim, minus the overdue premium.

Answer

Health insurance policies have a Grace Period provision that allows for late premium payments without the policy lapsing. For policies with premiums paid quarterly, the grace period is typically 31 days. Since the claim occurred only 10 days after the due date, the policy is still in force. The insurer will pay the claim but will deduct the amount of the outstanding premium.

Question 2

Which of the following mandatory health policy provisions prevents an insurer from voiding a policy for misstatements in the application after two years, except in cases of fraud?

Accepted Answer

Time Limit on Certain Defenses

Answer

The Time Limit on Certain Defenses provision, also known as the Incontestability clause, states that after a policy has been in force for a specified period (usually two years), the insurer cannot use misstatements on the application to void the policy or deny a claim, unless those misstatements were fraudulent.

Question 3

An individual's health insurance policy lapses due to nonpayment of premium. If the insured applies for reinstatement and the insurer does not require a new application, when is the policy considered reinstated?

Accepted Answer

Automatically upon acceptance of the late premium by the insurer.

Answer

According to the Reinstatement provision, if a lapsed policy is reinstated and the insurer accepts the overdue premium without requiring a new application, the policy is automatically reinstated. Accidents are covered immediately upon reinstatement, but there is typically a 10-day waiting period for sickness coverage to prevent adverse selection.

Question 4

Under the uniform policy provisions, an insured must provide written notice of a claim to the insurer within how many days of a loss?

Accepted Answer

20 days

Answer

The Notice of Claim provision requires the insured to give written notice to the insurer within 20 days after a covered loss occurs, or as soon as reasonably possible. This timely notification allows the insurer to begin the claims investigation process.

Question 5

After an insurer receives a notice of claim, the Claim Forms provision requires the insurer to furnish the claimant with the necessary forms within how many days?

Accepted Answer

15 days

Answer

The Claim Forms provision mandates that an insurer must provide the claimant with the required claim forms within 15 days of receiving the notice of claim. If the insurer fails to do so, the claimant can submit the proof of loss in any written form.

(EXAMFX) Exam FX Insurance Practice Test

(EXAMFX) Exam FX Insurance Practice Test

EXAMFX - Exam FX Insurance Health Policy Provisions Questions and Answers