Health Policy Provisions Flashcards
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Read the first 7 Health Policy Provisions flashcards as text
A health insurance policy is issued with an error in the premium rate. Under which provision can the insurer correct this error after the policy is delivered?
Answer: Misstatement of Age
The Misstatement of Age provision (and analogous rating provisions) allows the insurer to adjust premiums or benefits when underwriting information such as age was incorrectly stated.
An insured changes from a high-risk occupation to a lower-risk occupation and notifies the insurer. Under the Change of Occupation provision, the insurer should:
Answer: Reduce the premium or increase benefits proportionally
When an insured moves to a lower-risk occupation, the Change of Occupation provision requires the insurer to reduce the premium or increase benefits to reflect the lower risk.
Which provision protects an insured's health coverage from being canceled by the insurer solely because the insured filed claims?
Answer: Guaranteed Renewability provision
A Guaranteed Renewable policy gives the insured the right to renew coverage and prohibits the insurer from canceling the policy for any reason other than non-payment of premium, though premiums may be adjusted by class.
Under a Noncancellable and Guaranteed Renewable health policy, the insurer:
Answer: Cannot cancel and cannot raise premiums during the policy period
A Noncancellable and Guaranteed Renewable policy gives the insured the strongest protection: the insurer cannot cancel the policy and cannot increase premiums during the policy period.
The Proof of Loss provision requires an insured to submit written proof of loss to the insurer within how many days of a loss?
Answer: 90 days
Under the standard Proof of Loss provision, the insured must submit written proof within 90 days of a covered loss, or as soon as reasonably possible.
Which health policy provision gives the insurer the right to recover benefit payments made on behalf of the insured from a liable third party?
Answer: Subrogation provision
The Subrogation provision allows the insurer to recover from a negligent third party amounts it paid to the insured for losses caused by that third party.
Under the Assignment provision in a health insurance policy, the policyowner may assign benefits:
Answer: Only with the insurer's written consent
Most health policies require the insurer's written consent before the policyowner can assign policy benefits or rights to another party.