Lesson 17 Quiz

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NAIC Model Health Insurance Policy Provisions

In the NAIC Uniform Health Insurance Policy Provision Law, ______ policy provisions are outlined.

A clause is an article in a document that establishes the rules in the contract that both the insured and the insurance company must adhere to.

Match the following mandatory provisions with their respective definitions.

a)	States that the insurance policy represents the contract between the insurer and the policyowner in its entirety.
b)	This provision is akin to the Incontestability Clause in life insurance policies.
c)	Allows the policyowner a little leeway in paying premiums on time.
d)	Allows the restoration of a policy that lapsed due to late premium payments back to its original active status.
e)	Pertains to the timely notice given to the insurer when a claim is being made.
f)	Outlines the insurer's responsibility to provide the claimant with the specific forms the insurer requires.
a) Entire Contract b) Time Limit on Certain Defenses c) Grace Period d) Reinstatement e) Notice of Claim f) Claim Forms Lesson 17.1.1

Under the legal actions provision, Florida's statute prohibits insureds from taking legal action against an insurer due to a disputed claim for 60 days from the date of proof of loss and sets the statute of limitation at ____ years.

Under the unpaid premiums provision, how is a benefit payable to the insured or beneficiary if there are any unpaid premiums?

Under the cancelation provision, the insurance company must notify the insured ____ days in advance if the insurer exercises the right to cancel the policy.

Match the following optional provisions with their respective definitions.

a)	A person may occupy more than one policy with an insurer; however, this provision protects the company and does not allow the coverage to exceed a specified amount.
b)	If the insured is connected with a felony or has an occupation that is deemed against the law and incurs injury, the insurance company is not held responsible.
c)	The insurer is not responsible for any loss that occurs while the insured is intoxicated or under the influence of narcotics unless drugs were administered by a physician.
d)	When the insurance company exercises its right to cancel a policy, the insured must be notified 45 days in advance and must be reimbursed for any prepaid premiums.
e)	All conflicts regarding state statutes of the state the insured lives in are automatically adjusted at the time the policy is issued.
f)	When a benefit is payable to the insured or beneficiary, if there are any unpaid premiums they will be deducted at that time.
a) Other Insurance in This Insurer b) Illegal Occupation c) Intoxicants and Narcotics d) Cancelation e) Conformity with State Statutes f) Unpaid Premiums Lesson 17.1.2

Under the misstatement of age clause when dealing with health insurance if it was found that the insured person stated on their application that they were older and were consequently charged a higher premium than they should have been, what adjustment would be made?

Common Exclusions or Restrictions

Under what conditions can waivers for impairments be removed?

Which of the following is(are) typically excluded in health insurance policies?

LESSON 17: HEALTH INSURANCE POLICY PROVISIONS

Lesson 17 Quiz

NAIC Model Health Insurance Policy Provisions

Common Exclusions or Restrictions