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An accident and health insurance policy defines an injury as “bodily injury by accidental means”. For an injury to be covered on this policy, what is required? A. The accident must be external and violent B. The cause of the accident must be intentional C. Only the injury resulting from an accident must be unintentional D. Both the cause and the result of an accident must be unintentional
D. Both the cause and the result of an accident must be unintentional
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An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?
Megan has covered medical expenses of $15,500. Her health insurance policy has a $1,000 calendar year deductible, 20% coinsurance and $2,500 stop loss. What amount will her Insurance Company pay?
$12,000 ($15,500 – $1,000) = $14,500 $14,500 x 0.2 = 2,900 2,900 > 2,500 14,500 – 2,500 = 12,000
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Which of the following statements pertaining to health insurance policy premium factors is correct?
Health insurance policies are paid for on a year-by-year basis and are subject to periodic increases
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Which of the following is NOT required in the Outline of Coverage for a health insurance policy?
Projection of the policy’s future costs ( “Projection of the policy’s future costs”. A table indicating the policy’s projected future costs is not required in an Outline of Coverage.
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T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition?
Insurer will likely treat as a pre-existing condition which may not be covered for one year
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Which of the following is NOT required in the Outline of Coverage for a health insurance policy? Explanation of the policy’s benefits Listing of the policy’s exclusions and limitations Projection of the policy’s future costs Explanation of the policy’s renewal and cancellation provisions
Projection of the policy’s future costs
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Which of the following is the most valid reason for a person to purchase a specified (dread) disease health insurance policy? A) He wants to make sure that he and his family are protected against a major illness. B) Her family has a history of cancer, and she is concerned that she might contract the disease. C) He has been diagnosed with heart disease. D) She wants coverage against the risk of such illnesses as AIDS, tuberculosis, and diabetes.
B) Her family has a history of cancer, and she is concerned that she might contract the disease.
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When a health insurance policy is purchased in the state of New York, the insured may cancel the policy and receive a premium refund within a) 90 days. b) 10 days. c) 20 days. d) 30 days.
c) 20 days. The Free Look Provision allows for an insured to review his/her policy once it has been delivered; if the insured decides to return it within a certain time period, the premium will be refunded. The Free Look time period varies from state to state. In New York the insured can review the policy from anywhere between 10 and 20 days.
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the reason for a condination of benefites statement is a health insurance policy is
to prevent duplication or pverlappimg of pymts for the same medical expense
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