Which of the following statements describes what an accident and health policyowner may not do?

Which of the following is the best definition of a limited accident policy?

Which of the following is the best definition of a Limited Accident Policy ? A Limited Accident Policy restricts benefits to those injuries and causes of loss named in the policy . For example, a person injured in a car accident , must be a passenger in/on a ‘common carrier’ not a private passenger vehicle.

What should the insured do if the insurer fails to send the correct forms under the claims forms provision of a health policy?

If the insurer does not supply claim forms to the insured for submitting proof of loss within 15 days of receiving notice of the claim , the insured may submit proof of loss on any piece of paper or in any manner the insured wishes. The insurer will be required to accept this as proof of loss.

Which is considered a mandatory provision?

Payment of Claims is considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions . n an Accident & Health policy, the insuring clause states the amount of benefits to be paid.

When an insurance company sends a policy to the insured with an attached application the element?

When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the? Entire Contract provision. An insured must notify an insurer of a medical claim within how many days after an accident? 20.

How long is a benefit for a major medical expense plan?

one to three years

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Which of the following types of policies pays a stated amount for each day an individual is hospitalized?

Which of the following types of policies pays a stated amount for each day an individual is hospitalized ? A hospital indemnity policy pays a specified amount on a daily , weekly, or monthly basis to the insured while the insured is confined to a hospital.

What is the payment of claims provision?

A time of payment of claims provision states the number of days that the insurance company has to pay or deny a submitted claim . This provision is included to minimize the amount of time that a policyholder has to wait for his/her payment or for a decision about his/her claim .

What provisions are mandatory for health insurance policies?

a physical exam and autopsy provision – allows an insurance company to request regular physical exams or an autopsy. a legal actions clause – the minimum and maximum amount of time the policyholder can take legal action after providing proof of loss.

How long is the grace period for health insurance policies with other than weekly or monthly due premiums?

The grace period for health insurance is usually 90 days if both of the following are true: You have a Marketplace plan and qualify for advance payments of the premium tax credit.

Which health policy clause specifies the amount of benefits?

Which health policy clause specifies the amount of benefits to be paid? “Insuring”. In an Accident & Health policy , the insuring clause states the amount of benefits to be paid. “After an insured has become totally disabled as defined in the policy “.

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What is a reinstatement condition?

A reinstatement clause is an insurance policy clause that states when coverage terms are reset after the insured individual or business files a claim due to previous loss or damage. Reinstatement clauses don’t usually reset a policy’s terms, but they do allow the policy to restart coverage for future claims.

What is a provision in insurance?

Policy provisions are clauses in an insurance contract that lay out the exact conditions for which coverage is provided and for what amounts, along with exclusions and other restrictions.

Which optionally renewable health policies the insurer may?

With an Optionally Renewable policy, the insurance company may review the policy annually and choose whether or not to renew it. What is the purpose of the Time of Payment of Claims provision? The purpose of the Time of Payment of Claims provision is to prevent the insurance company from delaying claim payments.

What is a short term medical expense policy?

SHORT TERM DURATION MEDICAL EXPENSE COVERAGE: The policy is designed to provide coverage for hospital, medical , and surgical expenses incurred as a result of Medically Necessary care for a covered Sickness, Mental Illness or Injury during a Benefit Period .

What are the mandatory uniform provisions?

Mandatory Uniform Policy Provisions The provisions that cover the responsibilities of the policyholder include requirements that they notify the insurer of a claim within 20 days of a loss, provide proof of the extent of that loss, and update beneficiary information when changes take place.

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