XCEL Health Insurance Policy Provisions Exam 2023 with
complete solution
T files a claim on his Accident and Health policy after being treated for an illness. The
insurance company believes that T misrepresented his actual health on the initial
insurance application and is, therefore, disputing the claim's validity. The provision that
limits the time period during which the company may dispute a claim's validity is called
time limit on certain defenses
Periodic health claim payments MUST be made at least:
monthly
The sections of an insurance contract which limit coverage are called:
exclusions
An insurance company receives E's application for an individual health policy. E did not
complete all of the medical history questions because she could not remember the
exact dates. E signed the policy and submitted it to the insurance company anyway. A
few weeks later, E suffers a heart attack and is hospitalized without completing the
medical history questions and paying the initial premium. E is not insured. Which of the
following clauses details the conditions that E did not meet?
consideration clause
What is the purpose of the Time of Payment of Claims provision?
prevents delayed claim payments made by the insurer
K has a health policy that must be renewed by the insurer and the premiums can only
be increased if applied to the entire class of insureds. This type of policy is considered
guaranteed renewable
A Disability Income policyowner recently submitted a claim for a chronic neck problem
that has now resulted in total disability. The original neck injury occurred before the
application was taken 5 years prior. The neck injury was never disclosed to the insurer
at the time of application. How will the insurer handle this claim?
claim will be paid and coverage will remain in force
When does a Probationary Period provision become effective in a health insurance
contract?
at the policy's inception
The insuring clause
states the scope and limits of the coverage
What type of rider would be added to an Accident and Health policy if the policyowner
wants to ensure the policy will continue if he/she ever becomes totally disabled?
waiver of premium rider
Which of these is considered a mandatory provision?
payment of claims
According to the Time Limit of Defenses provision in an Individual Health Insurance
Policy, nonfraudulent misstatements first become incontestable:
two years from the date of the policy was issued
An insured must notify an insurer of a medical claim within how many days after an
accident?
20
, What must the policyowner provide to the insurer for validation that a loss has
occurred?
proof of loss
Which type of renewability best describes a Disability Income policy that covers an
individual until the age of 65, but the insurer has the right to change the premium rate?
guaranteed renewable
Which of the following provisions specifies how long a policyowner's health coverage
will remain in effect if the policyowner does not pay the premium when it is due?
grace period
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries
sustained in an accident. J's age as stated on the application five years ago was found
to be understated by ten years. Which of the following actions will the insurance
company take?
the insurer will adjust the benefit to what the premiums paid would have purchased at
the insured's actual age
Which of the following is NOT included in the policy face?
exclusion
Which of the following statements describes what an Accidental and Health policyowner
may NOT do?
adjust the premium payments
What is considered to be a characteristic of a Conditionally Renewable Health
Insurance policy?
premiums may increase at time of renewal
J purchased a Disability Income Policy that ONLY J can terminate and on which the
rates will never increase above those illustrated in the policy. Which of the following
types of policies did J purchase?
noncancelable
G is involved in an automobile accident as a result of driving while intoxicated and
suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's
policy, who is responsible for paying the medical bills?
the insured
The clause identifying which losses resulting from an accident or sickness are insured
by the policy is called the
insuring clause
Health insurance benefits NOT covered due to an act of war are:
excluded by the insurer in the contract provisions
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of
time after the premium due date during which the policy remains in force even though
the premium has not been paid?
31 days
If an insurance company issues a Disability Income policy that it cannot cancel or for
which it cannot increase premiums, the type of renewability that best describes this
policy is called
noncancellable
Which of the following health policy provisions states that the producer does NOT have
the authority to change the policy or waive any of its provisions?
complete solution
T files a claim on his Accident and Health policy after being treated for an illness. The
insurance company believes that T misrepresented his actual health on the initial
insurance application and is, therefore, disputing the claim's validity. The provision that
limits the time period during which the company may dispute a claim's validity is called
time limit on certain defenses
Periodic health claim payments MUST be made at least:
monthly
The sections of an insurance contract which limit coverage are called:
exclusions
An insurance company receives E's application for an individual health policy. E did not
complete all of the medical history questions because she could not remember the
exact dates. E signed the policy and submitted it to the insurance company anyway. A
few weeks later, E suffers a heart attack and is hospitalized without completing the
medical history questions and paying the initial premium. E is not insured. Which of the
following clauses details the conditions that E did not meet?
consideration clause
What is the purpose of the Time of Payment of Claims provision?
prevents delayed claim payments made by the insurer
K has a health policy that must be renewed by the insurer and the premiums can only
be increased if applied to the entire class of insureds. This type of policy is considered
guaranteed renewable
A Disability Income policyowner recently submitted a claim for a chronic neck problem
that has now resulted in total disability. The original neck injury occurred before the
application was taken 5 years prior. The neck injury was never disclosed to the insurer
at the time of application. How will the insurer handle this claim?
claim will be paid and coverage will remain in force
When does a Probationary Period provision become effective in a health insurance
contract?
at the policy's inception
The insuring clause
states the scope and limits of the coverage
What type of rider would be added to an Accident and Health policy if the policyowner
wants to ensure the policy will continue if he/she ever becomes totally disabled?
waiver of premium rider
Which of these is considered a mandatory provision?
payment of claims
According to the Time Limit of Defenses provision in an Individual Health Insurance
Policy, nonfraudulent misstatements first become incontestable:
two years from the date of the policy was issued
An insured must notify an insurer of a medical claim within how many days after an
accident?
20
, What must the policyowner provide to the insurer for validation that a loss has
occurred?
proof of loss
Which type of renewability best describes a Disability Income policy that covers an
individual until the age of 65, but the insurer has the right to change the premium rate?
guaranteed renewable
Which of the following provisions specifies how long a policyowner's health coverage
will remain in effect if the policyowner does not pay the premium when it is due?
grace period
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries
sustained in an accident. J's age as stated on the application five years ago was found
to be understated by ten years. Which of the following actions will the insurance
company take?
the insurer will adjust the benefit to what the premiums paid would have purchased at
the insured's actual age
Which of the following is NOT included in the policy face?
exclusion
Which of the following statements describes what an Accidental and Health policyowner
may NOT do?
adjust the premium payments
What is considered to be a characteristic of a Conditionally Renewable Health
Insurance policy?
premiums may increase at time of renewal
J purchased a Disability Income Policy that ONLY J can terminate and on which the
rates will never increase above those illustrated in the policy. Which of the following
types of policies did J purchase?
noncancelable
G is involved in an automobile accident as a result of driving while intoxicated and
suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's
policy, who is responsible for paying the medical bills?
the insured
The clause identifying which losses resulting from an accident or sickness are insured
by the policy is called the
insuring clause
Health insurance benefits NOT covered due to an act of war are:
excluded by the insurer in the contract provisions
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of
time after the premium due date during which the policy remains in force even though
the premium has not been paid?
31 days
If an insurance company issues a Disability Income policy that it cannot cancel or for
which it cannot increase premiums, the type of renewability that best describes this
policy is called
noncancellable
Which of the following health policy provisions states that the producer does NOT have
the authority to change the policy or waive any of its provisions?
