EXAMFX Health Policy Provisions 2

Question 1

Under the Entire Contract provision, which documents must be included to form the complete insurance contract?

Accepted Answer

The policy, application, and all attached riders and endorsements

Answer

The Entire Contract provision requires the policy, the signed application, and any attached riders or endorsements to constitute the full agreement.

Question 2

A health policy's Grace Period provision typically allows how many days for an individual policy after a missed premium?

Accepted Answer

31 days

Answer

Individual health insurance policies generally provide a 31-day grace period during which the policy remains in force even if the premium is not paid on time.

Question 3

Which provision prevents an insurer from denying a claim by citing a misrepresentation in the application after the policy has been in force for two years?

Accepted Answer

Time Limit on Certain Defenses provision

Answer

The Time Limit on Certain Defenses (incontestability) provision bars the insurer from voiding the policy or denying claims based on misrepresentations after the policy has been in force for a specified period, typically two years.

Question 4

If an insured submits a proof of loss for a health claim, within how many days must the insurer pay the claim under a standard Claim Settlement provision?

Accepted Answer

60 days

Answer

Under the standard Claims Settlement provision, the insurer must pay the claim within 60 days of receiving a satisfactory proof of loss.

Question 5

The Reinstatement provision in a health policy requires that a reinstated policy cover which type of loss immediately?

Accepted Answer

Accidental injury only

Answer

Upon reinstatement, accidental injury losses are covered immediately, while losses due to sickness are typically subject to a 10-day waiting period.

(EXAMFX) Exam FX Insurance Practice Test

(EXAMFX) Exam FX Insurance Practice Test

EXAMFX Health Policy Provisions 2