EXAMFX Health Policy Provisions 5

Question 1

A health policy provision stating that 'no statement made by any agent shall modify this contract' reflects which mandatory provision?

Accepted Answer

Entire Contract provision

Answer

The Entire Contract provision limits the contract to the policy and attached documents, preventing agents from altering terms through oral statements or side agreements.

Question 2

When a policy lapses and the insured later pays the overdue premium to reinstate coverage, which condition must typically be met for reinstatement?

Accepted Answer

Payment of premium and evidence of insurability

Answer

Reinstatement typically requires payment of the overdue premium plus evidence of insurability, confirming the insured's health has not materially changed during the lapse.

Question 3

The Time Limit on Certain Defenses provision prohibits an insurer from contesting a policy after it has been in force for a set period, EXCEPT in cases of:

Accepted Answer

Fraudulent misrepresentations

Answer

Even after the contestability period expires, an insurer may still void a policy or deny claims based on intentional fraudulent misrepresentations by the applicant.

Question 4

Under the Payment of Claims provision, disability income benefits are typically payable:

Accepted Answer

Monthly, throughout the period of disability

Answer

Disability income benefits are payable periodically—typically monthly—throughout the period of covered disability, providing ongoing income replacement.

Question 5

If an insured is injured and receives benefits from both a health insurer and an at-fault driver's auto liability insurer, which provision allows the health insurer to seek reimbursement from the auto settlement?

Accepted Answer

Subrogation provision

Answer

Subrogation allows the health insurer to recover amounts it paid from the proceeds of any settlement the insured receives from the negligent third party.

(EXAMFX) Exam FX Insurance Practice Test

(EXAMFX) Exam FX Insurance Practice Test

EXAMFX Health Policy Provisions 5