Chapter 8 - Health Insurance Policy
Provisions 100+ Test Questions
With Detailed Verified Answers /
Already Graded A / NEWEST
2025/2026.
Which Accident and Health policy provision addresses preexisting conditions? Answer
Time limit on certain defense provisions
(applies to preexisting conditions, initial application, and new claims. Has a specific time
period to defend their validity.)
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
Answer Time limit on certain defenses
(The insurance company can contest your application for up to 2 years from the date of
application. That is the TIME LIMIT to DEFEND your application answers. After that
point, the application is considered incontestable.)
The policy provision that entitles the insurer to establish conditions the insured must
meet while a claim is pending is... Answer Time limit on certain defenses
(Insurance may set certain conditions that must be met for your claim to be valid. There
is a time limit for how you they can expect you to be injured.)
With any insurance policy, what is the purpose of the Grace Period? Answer Give the
policy owner additional time to pay past due premiums
(Grace period gives policyowner extra time to pay a premium after the due date.)
Which of the following provisions specifies how long a policyowner's insurance
coverage will remain in effect if the policyowner does not pay the premium when it is
due? Answer Grace period
(ensures the policyowner does not lose their insurance.)
, Monthly premium individual health insurance policies must provide a grace period of at
least... Answer 10 days
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? Answer 31
days
(If an insured pays their premium less frequently than monthly (quarterly, semi-annually,
or annually), the usual grace period is 31 days.)
Which of the following provisions is NOT required in HMO contracts or certificates?
Answer Seven-day grace period
(HMOs must provide grace period of at LEAST 10 days.)
An insured is past due on his life insurance premium, but is still within the Grace Period.
What will the beneficiary receive if the insured dies during this Grace Period? Answer
Full face amount minus any past due premiums
M had an annual life insurance premium payment due January 1. She died January 10
without making the premium payment. What action will the insurer take? Answer Pay
face amount minus the past due premium
N is covered by a Term Life policy and does not make the required premium payment
which was due August 1. N dies September 15. What action will the insurer take?
Answer Claim will be denied
The Notice of Claims provision requires a policyowner to Answer Notify an insurer of
a claim within a specified time
(If the insured does not notify the insurance company of a claim within 20 days, the
insurance company can deny payment for the claim.)
The provision that defines to whom the insurer will pay benefits to is called... Answer
Payment of Claims
(May be medical service provider, the insured, or some other beneficiary.)
D, the beneficiary under her husband's AD&D policy, submits an accidental death claim
on May 1, 2010 following his death. However, the company denies the claim on the
basis that death was due to natural causes. She decides to talk to her attorney. What is
the earliest date for taking legal action against the insurer. Answer July 1, 2010
(An insured must wait 60 days after filing a written Proof of Loss for a Disability Income
claim or AD&D claim prior to taking legal action against the insurer.)
Provisions 100+ Test Questions
With Detailed Verified Answers /
Already Graded A / NEWEST
2025/2026.
Which Accident and Health policy provision addresses preexisting conditions? Answer
Time limit on certain defense provisions
(applies to preexisting conditions, initial application, and new claims. Has a specific time
period to defend their validity.)
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
Answer Time limit on certain defenses
(The insurance company can contest your application for up to 2 years from the date of
application. That is the TIME LIMIT to DEFEND your application answers. After that
point, the application is considered incontestable.)
The policy provision that entitles the insurer to establish conditions the insured must
meet while a claim is pending is... Answer Time limit on certain defenses
(Insurance may set certain conditions that must be met for your claim to be valid. There
is a time limit for how you they can expect you to be injured.)
With any insurance policy, what is the purpose of the Grace Period? Answer Give the
policy owner additional time to pay past due premiums
(Grace period gives policyowner extra time to pay a premium after the due date.)
Which of the following provisions specifies how long a policyowner's insurance
coverage will remain in effect if the policyowner does not pay the premium when it is
due? Answer Grace period
(ensures the policyowner does not lose their insurance.)
, Monthly premium individual health insurance policies must provide a grace period of at
least... Answer 10 days
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? Answer 31
days
(If an insured pays their premium less frequently than monthly (quarterly, semi-annually,
or annually), the usual grace period is 31 days.)
Which of the following provisions is NOT required in HMO contracts or certificates?
Answer Seven-day grace period
(HMOs must provide grace period of at LEAST 10 days.)
An insured is past due on his life insurance premium, but is still within the Grace Period.
What will the beneficiary receive if the insured dies during this Grace Period? Answer
Full face amount minus any past due premiums
M had an annual life insurance premium payment due January 1. She died January 10
without making the premium payment. What action will the insurer take? Answer Pay
face amount minus the past due premium
N is covered by a Term Life policy and does not make the required premium payment
which was due August 1. N dies September 15. What action will the insurer take?
Answer Claim will be denied
The Notice of Claims provision requires a policyowner to Answer Notify an insurer of
a claim within a specified time
(If the insured does not notify the insurance company of a claim within 20 days, the
insurance company can deny payment for the claim.)
The provision that defines to whom the insurer will pay benefits to is called... Answer
Payment of Claims
(May be medical service provider, the insured, or some other beneficiary.)
D, the beneficiary under her husband's AD&D policy, submits an accidental death claim
on May 1, 2010 following his death. However, the company denies the claim on the
basis that death was due to natural causes. She decides to talk to her attorney. What is
the earliest date for taking legal action against the insurer. Answer July 1, 2010
(An insured must wait 60 days after filing a written Proof of Loss for a Disability Income
claim or AD&D claim prior to taking legal action against the insurer.)
