Claims and Benefits Flashcards
6 cards from real Life & Health Insurance Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Claims and Benefits flashcards as text
When a group health insured loses coverage and exercises COBRA continuation, who pays the premium?
Answer: The insured pays up to 102% of the group rate
Under COBRA, the former employee pays the full group premium plus a 2% administrative fee, up to 102% of the group rate.
What is 'coordination of benefits' (COB) designed to prevent?
Answer: Over-insurance and duplicate payments exceeding actual expenses
COB rules ensure that when a person is covered by two health plans, total payments do not exceed 100% of the actual medical expenses.
Which of the following deaths is most likely EXCLUDED from a standard life insurance policy?
Answer: Death by suicide in the first two years
Most life policies exclude suicide during an initial period (usually 2 years) to deter adverse selection.
Under the 'entire contract' provision, what documents make up the insurance contract?
Answer: The policy and the application
The entire contract provision states that the policy and the attached application together constitute the complete agreement between the parties.
A beneficiary chooses the 'fixed period' settlement option. This means they will receive:
Answer: Equal installments over a set number of years
Under the fixed period option, proceeds plus interest are paid in equal installments over a specific number of years chosen by the beneficiary.
What is the primary purpose of the 'notice of claim' provision in a health insurance policy?
Answer: To require the insured to notify the insurer of a loss within a specified time
The notice of claim provision obligates the insured to inform the insurer of a loss, typically within 20 days, so the insurer can begin the claims process.