Kentucky Health

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Kentucky Health & Life (Commonwealth Schools of Insurance - PT 4) [1-6] with 100% Correct Answers | Verified | Latest Update 2024| Already Passed What is the difference between the terms accident and sickness as used in insurance policies? - ✔✔ - an accident occurs accidentally, - a sickness is an illness or disease is not the result of an accident. Common accident benefits under insurance policies include all of the following: - ✔✔ - accidental death benefit - accidental dismemberment - loss of income due to an accidental injury 3) Common accident benefits include all of the following: - ✔✔ - hospital expenses such as room and board - surgical procedures and expenses - medical expenses

The following are correct statements about the term "dismemberment" - ✔✔ - it means actual limb severance at or above the main joint. - it may refer to loss of sight or hearing. - loss must be complete and permanent Under an accident policy, when dismemberment occurs, the amount paid to the insured is the: - ✔✔ capital sum The following are correct statements about payment for dismemberment under accident policies: - ✔✔ - for loss of sight to be considered dismemberment, loss must be complete and permanent. - under most policies, the full capital sum is paid for a double loss, for example, both feet, whereas only a portion of the capital loss is paid for a single loss, for example, one foot. - policies specify exactly the type of dismemberment required for payment for all or part of the capital sum In most accident policies, what is the difference between the principal sum and the capital sum? - ✔✔ - the principal sum is paid for accidental death, - the capital sum pays for dismemberment.

Which of the following would be a tertiary beneficiary? - ✔✔ the beneficiary in line after the contingent beneficiary How do the terms "accidental bodily injury" and "accidental bodily injury by accidental means" differ? - ✔✔ - accidental means is more restrictive than accidental bodily injury. Which of the following is the most literal interpretation of "accident," an event completely unforeseen and unintended? - ✔✔ accidental means Which of the following is a correct statement about accidental death and time limits? - ✔✔ most policies stipulate that accidental death benefits will be paid only if death occurs with 90 days of the accident. An insured has an A&H Policy with the phrase "Accidental Bodily Injury" used to define what constitutes accidental injury or death: - ✔✔ this phrase is less restrictive than the phrase "accidental means." same as last 4.1.13 - ✔✔ 4.1.13

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Each of the following is a function of Accident insurance: - ✔✔ - to provide benefits for the accidental loss of life, limb, or sight - to provide benefits for the accidental loss of time away from the job as a result of an accident - to provide benefits for the payment of hospital, surgical, and medical expenses incurred in the treatment of accidental injuries The "Principle Sum" of a policy of Health and Accident insurance - ✔✔ is the sum specified in the policy payable for loss of life caused by accident Which of the following accidental injuries would be eligible for dismemberment benefits under an Accident & Health Policy? - ✔✔ loss of 1 foot Which statement best defines an Accident Policy? - ✔✔ an insurance policy which provides payment for accidental death, dismemberment, or loss of time The book describes an accident as: - ✔✔ an event which is unforeseen an unintended

Which of the following phrases is more restrictive, that is less likely to pay a benefit? - ✔✔ accidental bodily injury by accidental means In A&S and A&H insurance policies, if a policy is "accident" only, it pays only when the event is - ✔✔ for loss by "accident" principal sum is the payment for: - ✔✔ loss of life by accident An applicant purchased an A&H policy on his wife that included an Accidental Death and Dismemberment benefit. He named himself as beneficiary and specified that the Death benefits were to be payable to his son if he, the applicant, were to predecease his wife. In this situation, the applicant's son would be considered the - ✔✔ contingent beneficiary Any death benefit under an A&H insurance contract is limited to deaths caused by which of the following? - ✔✔ accidental injury only Which of the following statements about accidental death and dismemberment insurance is correct? - ✔✔ the amount payable for the loss of one member is one-half of the principle sum called capital sum.

Under the terms of the typical individual ACCIDENTAL DEATH and DISMEMBERMENT policy, the following would NOT qualify as dismemberment: - ✔✔ - Sally Davis loses all the fingers on her left hand in a factory accident. - Ed Thomas, who is right-handed, permanently loses the use of his right hand and arm as the result of an automobile accident Why is disability sometimes called the "living death?" - ✔✔ because income generally stops during a period of disability, but day-to-day living expenses continue Which of the following is a function of disability income insurance? - ✔✔ to continue to receive a portion of earnings during a disability Which of the following is a correct statement about defining "total disability" in a disability income policy? - ✔✔ total disability could be defined using the insureds own or any occupation. Mary receives disability income benefits because she was hurt on the job unloading freight. She will collect under the policy as long as she is not able to unload freight. Which of the total disability definitions does Mary's policy use? - ✔✔ own occupation

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Which of the following disability income policies combines both the "own occupation" and "any occupation" definitions of total disability to cover separate periods of a single disability? - ✔✔ long-term policies What is the term for a condition, for example, loss of two limbs, total and permanent blindness, or loss of speech and hearing, that automatically qualifies an insured for total disability even if the insured is able to work? - ✔✔ presumptive disability All of the following are correct statements about the probationary period under disability policies: - ✔✔ - no benefits are paid during the probationary period. - the probationary period generally applies to sickness but not to accidents. - the probationary period begins when the policy goes into effect. Which of the following is a correct statement about the probationary period under disability policies? - ✔✔ its purpose is to relieve the insurer of paying benefits for preexisting conditions.

All of the following are correct statements about the benefit period under disability policies: - ✔✔ - short-term disability policies have shorter benefit periods than long-term disability policies. - the benefit period is the length of time the policy pays benefits. - long-term policies may pay benefits as long as to age 65 Which of the following is an example of a confining disability? - ✔✔ sue has tuberculosis and cannot go outside her home during recovery. When a person is not totally disabled and can perform one or more important duties of his or her occupation, the disability is said to be: - ✔✔ partial the following are correct statements about partial disability - ✔✔ - partial disability generally applies to accident disability. - the typical partial disability indemnity is 50 percent of the total disability indemnity. - a partially disabled person can still perform one or more important duties of his or her occupation.

Misty is a receptionist. She takes a tumble on the ski slopes and does not appear to be injured. A week later she begins having headaches, later dizziness and slurred speech. Within a month she is diagnosed with a severe brain injury, and her language skills are impaired. Which of the following types of disability does Misty have? - ✔✔ delayed Fred suffers a back injury and is in traction for two months, during which time he develops pneumonia. Can Fred collect double disability benefits as a result of his accident and his sickness? - ✔✔ no because this is only one loss of time Are nondisabling injuries covered under disability income policies? - ✔✔ some provide for a small percentage of the total disability indemnity for medical consultations and minor surgery. Which of the following are short-term benefits available under a disability income policy with an additional premium paid? - ✔✔ - supplemental income to provide additional income during the first several months of a long-term disability - hospital income to pay a stipulation amount per day when the insured is hospitalized - elective benefits providing for the payment of a lump sum for certain injuries rather than weekly or monthly benefits

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All of the following are correct statements about key person disability insurance: - ✔✔ - some policies pay benefits directly to the key person as income. - some policies pay benefits to the employer to train and hire a replacement. - benefits paid to an employer can compensate for sudden loss of business income. The following expenses would be covered by a business overhead expense policy: - ✔✔ - employee wages - rent - utilities The following are correct statements regarding partial disability payments: - ✔✔ - Partial Disability payments are often made as the result of accident disability - The usual partial disability benefit is 50% of the total disability benefit The Elimination or Waiting Period refers to: - ✔✔ the period after a disability commences and before you may begin receiving benefits. Recurrent Disability is a - ✔✔ disability, which is due to the same or a related cause of disability.

Disability due to the same or related cause of a previous disability is known as: - ✔✔ recurrent Following an accident, an insured is unable to perform any of the duties of an occupation. This condition is called: - ✔✔ total disability Which of the following policy/ies cover a loss which is classified as the living death? - ✔✔ d.i. policy (disability income) Which of the following definitions of disability is more likely to pay benefits? - ✔✔ any occupational definition In an A&H policy, an Elimination (Waiting) Period provision refers to the period - ✔✔ between the first day of disability and the day to which the disability must continue before it can result in the insured receiving benefits. Which of the following is a correct statement about medical expense coverage? - ✔✔ it may provide a broad range of benefits or only one or two coverages.

the following would be covered as a hospital expense under a medical expense: - ✔✔ - room and board - miscellaneous charges such ax x-rays, lab fees, and medical supplies - special diet Alice has a hospital expense policy that pays the room and board benefit on an indemnity basis. All of the following are correct: - ✔✔ - she receives a preestablished amount per day for a maximum number of days - indemnity plans are sometimes called "dollar amount" plans. - indemnity plans are less common that reimbursement plans. Arthur has a hospital expense policy that pays the room and board benefit on a reimbursement basis. All of the following are correct: - ✔✔ - reimbursement plans are also known as "expense incurred" plans. - depending on the policy, arthur is reimbursed for actual charges for a semiprivate room or a percentage of the actual charges with no dollar limit. - a maximum number of days eligible for reimbursement is specified.

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5) Which of the following is a correct statement about the miscellaneous medical expense benefit? - ✔✔ - its limit is usually separate from the room and board benefit and expressed as a multiple of the per-day room and board benefit. Frank's surgical expense policy pays for surgeon's fees and related costs. Benefit amounts for the most commonly performed procedures are listed. What type of plan does Frank have? - ✔✔ scheduled Gerry's surgical expense policy pays for surgeon's fees and related costs. The policy pays based on what is considered usual, customary, and reasonable in his area. What type of plan does Gerry have? - ✔✔ nonscheduled Hank's policy pays for physicians' nonsurgical expenses. All of the following are specified in the policy: - ✔✔ - the maximum number of physician visits per day - the maximum dollar amount per physician visit - the maximum number of days of coverage The following would be considered an Other Medical Expense Benefit: - ✔✔ - maternity - emergency first aid

- mental infirmity Which of the following is a correct statement about mental infirmity coverage as provided by medical expense insurance? - ✔✔ - benefits are typically lower than for physical infirmities. All of the following are common exclusions or limitations found in medical expense policies: - ✔✔ - preexisting conditions - suicide - self-inflicted injury All of the following are common exclusions or limitations found in medical expense policies: - ✔✔ - injury while committing a felony - elective cosmetic surgery - self-inflicted injury All of the following are correct statements about major medical coverage: - ✔✔ - it covers a broad range of medical expenses. - it has greater individual benefits and higher policy maximums than basic expense coverage.

- the two groups making up major medical are comprehensive and supplemental. When the insurer and insured share expenses above the deductible with the insurer carrying the bulk of the expense, which of the following mechanisms is in place? - ✔✔ Co-insurance (percentage participation) Marie has spent $10,000 in deductibles, coinsurance, and other out-of-pocket expenses under her major medical policy. Her insurer will now pay the entire cost of any remaining expenses up to a stated maximum. Which of the following mechanisms is in place here? - ✔✔ stop loss All of the following are correct statements about supplemental major medical benefits: - ✔✔ - the basic plan pays up to the policy limit with no deductible. - the supplemental policy operates identically to a comprehensive policy providing no first dollar coverage; a "corridor" deductible applies. - the basic policy and the supplemental policy contain separate deductibles. Assuming the same benefit period, how do per-cause and all-cause deductibles differ? - ✔✔ - with a per-cause deductible, the insured pays a deductible for the expenses incurred for the same injury or illness and subsequent deductibles for subsequent injuries or illnesses;

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- all expenses are accumulated to reach an all-cause deductible. Generally which of the following is true of deductibles in policies that insure families? - ✔✔ there is a single deductible rather than individual deductibles. Which of the following are benefits usually provided by a Hospital Policy? - ✔✔ - hospital room and board - x-rays - laboratory fees The payment the insured makes between the Basic Policy and the Major Medical part is called: - ✔✔ corridor deductible Each of the following is a common exclusion of Accident & Health Policies: - ✔✔ - war or any activity of war - pre-existing illness - injuries received while committing or attempting to commit a felony

Which plan has a "Corridor" deductible? - ✔✔ supplemental major medical policies An insured has a MAJOR MEDICAL policy that calls for a flat $2,000 deductible and 80%-20% participation. If the insured incurs medical expenses of $6,000, he would receive benefits of - ✔✔ $3,200 The payment the insured makes on a COMPREHENSIVE MEDICAL EXPENSE Policy, between the basic underlying COVERAGE and MAJOR MEDICAL, is called: - ✔✔ corridor deductible (integrated) The purpose of the Coinsurance Clause in MAJOR MEDICAL policies is to - ✔✔ motivate the insured to minimize unnecessary care. Intentional self-inflicted injuries are frequently excluded from coverage in which of the following types of policies? - ✔✔ - medical expense - disability income COMPREHENSIVE MEDICAL EXPENSE insurance combines which of the following coverages in one policy? - ✔✔ basic hospital/surgical and major medical

What is the major difference between stock and mutual insurers? - ✔✔ stock companies are owned by stockholders; mutuals are owned by policyholders. the following are origins of surplus from which to pay dividends: - ✔✔ - reserves - interest on investments - savings on expenses An insurer that has not been licensed in a particular state is called a(n): - ✔✔ unauthorized or nonadmitted company Blue Cross/Blue Shield cover which of the following expenses? - ✔✔ hospital/surgical Which of the following best describes the purpose of HMOs? - ✔✔ to manage healthcare and its costs through prepaid care and emphasizing prevention and early treatment Which of the following is one of the primary differences between HMOs and traditional insurance coverage? - ✔✔ - hmo insureds prepay for services;

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- traditional insurers provide services on a reimbursement basis. Which of the following preventive measures is paid for in advance for HMO insureds? - ✔✔ - routine physicals - well child exams - some diagnostic screenings HMOs provide for hospital, surgical, and medical treatment... - ✔✔ when services are needed Which of the following is a correct statement about HMOs and traditional insurers? - ✔✔ - hmos provide both coverage and services; traditional arrangements require separate providers and payors. Once an HMO's service area has been established, which of the following is correct? - ✔✔ employers in the service area with at least 25 employees that offer healthcare benefits must offer the hmo as an alternative to traditional plans.

When employers offer both an HMO and a traditional insurance plan, this is termed: - ✔✔ dual choice Ned belongs to an HMO that contracts with an individual medical group. The HMO pays the group, not the individual service providers. The group determines how to compensate the providers, and the individual providers remain entirely separate from the HMO. What kind of HMO does Ned have? - ✔✔ group Olivia belongs to an HMO in which physicians are paid employees of the HMO. The HMO owns the facility. What kind of HMO does Olivia have? - ✔✔ staff Paul belongs to an HMO that contracts with several medical groups and may contract with individual doctors, thereby increasing the pool of available providers. Groups are generally paid based on a monthly payment for each member; individual physicians are either paid via this capitation arrangement or a discounted fee. What kind of HMO does Paul have? - ✔✔ network Quinton belongs to an HMO in which the HMO contracts separately with groups and individual service providers. While providers are independent, payment is usually on a fee-for-service

basis negotiated in advance. What kind of HMO does Quinton have? - ✔✔ individual practice association An HMO that allows any providers who want to provide services for the HMO to do so as long as the conform to the HMO's requirements is termed: - ✔✔ open panel An HMO that limits the number of healthcare providers and members must use these providers in order to have their services prepaid is termed: - ✔✔ closed panel Which of the following services in an HMO required to provide? - ✔✔ - physician services - hospital inpatient services - outpatient medical services Are HMOs required to provide prescription drug benefits? - ✔✔ no, they are not required 20) With exception of emergencies, Kurt's HMO requires him to see his primary care physician who must authorize all of his healthcare. This system is called: - ✔✔ the gatekeeper system

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Which of the following is a correct statement about HMOs and accessibility? - ✔✔ members generally have access to their hmos 24 hours a day. Jennifer's managed care organization is a group of area independent hospitals and medical practitioners. They provide a range of services at a prearranged cost but on a fee-for service basis. Which of the following does she have? - ✔✔ Paid Provider Organization (PPO) the following are correct statements about PPOs - ✔✔ - ppos are less restrictive than hmos. - ppo members may use providers outside the network but at a higher cost. - ppos generally pay in full for emergency treatment regardless of where or by whom it is performed. Enrollment to individuals in a Health Maintenance organization (HMO) is: - ✔✔ voluntary A company licensed to sell insurance in a state is called - ✔✔ an admitted company The basis on which Health Maintenance Organizations (HMOs) provide health care is: - ✔✔ prepaid

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Select the correct statement. - ✔✔ a company chartered in indiana is referred to as a domestic company in indiana and a foreign company in all other states A policy which provides for the insured to share any surplus declared by the company is called a: - ✔✔ participating policy HMO's must operate within the following areas? - ✔✔ only in designated service areas Which statement(s) best describe(s) the difference between "Traditional" insurers and an HMO? - ✔✔ an hmo provides both the health insurance services and the health care coverages Which of the following "Typical Structures" of HMO's provides the maximum freedom to choose physicians and locations? - ✔✔ independent practice association model (ipa) Primary Care Physicians (PCPs) are sometimes referred to as: - ✔✔ gatekeeper

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33) PPOs and HMOs are often lumped together and referred to as: - ✔✔ managed health care system A company licensed to sell insurance in a state is called - ✔✔ an admitted company In an insurance contract, which of the following describes the general scope of coverage, provides definitions, and sets forth the conditions under which benefits will be paid? - ✔✔ insuring clause In a health insurance policy, the consideration clause: - ✔✔ - defines the consideration - states the date coverage begins - states the length of the initial coverage period Benefits under disability policies are generally paid: - ✔✔ as periodic income Benefits for expenses incurred under hospital, medical, surgical, and major medical policies are paid: - ✔✔ in lump sum reimbursements

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Benefits under accidental death and dismemberment policies are: - ✔✔ paid in a lump sum What is the difference between an absolute and a collateral assignment of an insurance policy? - ✔✔ - absolute assignment transfers all rights; - collateral assignment transfers only part of the rights, usually to secure debt. When can a policyowner cancel a policy? - ✔✔ - with notice to the insurer - by letting the policy lapse Which of the following best describes an optionally renewable health insurance policy? - ✔✔ the insurer may elect not to renew for any reason but only on the premium due date. Which of the following is a correct statement about a conditionally renewable health insurance policy? - ✔✔ the insurer may elect not to renew but only under the conditions specified in the policy. When can an insurer refuse to renew an optionally renewable policy? - ✔✔ only when a premium is due

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When may an insurer cancel a cancelable policy? - ✔✔ anytime as long as unearned premiums are returned to the insured. All of the following are correct statements about guaranteed renewable policies: - ✔✔ - premiums may be increased only for an entire class of insureds. - the guarantee to renew ends at a specified age. - renewal is guaranteed as long as the insured pays the premium. How do guaranteed renewable and noncancelable policies differ? - ✔✔ - an insurer can increase the premiums on a guaranteed renewable policy with an increase to an entire class of insureds; - noncancelable policies can never increase the premium. All of the following are examples of case management or claims control: - ✔✔ -Second surgical opinion - Precertification or prior authorization - Home health care, hospice care, or extended care

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All of the following are examples of case management or claims control: - ✔✔ - Concurrent and retrospective reviews - Outpatient and ambulatory services - Preventative care Herb's wife and teenage son are covered under his health insurance policy. Herb has a stroke and dies. Which of the following is true of his wife and son? - ✔✔ they may convert their coverage to a similar policy within 31 days without evidence of insurability. In most states, how long is a newborn automatically covered under his parents' policy? - ✔✔ 31 days In most states, when a covered dependent is mentally or physically handicapped, coverage must continue regardless of age provided: - ✔✔ - the child remains dependent on the policyowner for support - the policyowner pays the premiums Which of the following modifies a standard insurance contract and is incorporated into the body of the policy? - ✔✔ endorsement

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Will has a rider attached to his disability policy requiring his insurance company to forego premiums and continue the policy in force if he becomes totally disabled for at least 90 days. What kind of rider does Will have? - ✔✔ waiver of premium rider Which of the following is a correct statement about impairment riders? - ✔✔ - they are used to exclude coverage for a specific existing ailment or condition that would otherwise be covered - without the rider, the applicant may not be able to obtain coverage. - using the rider, the insurer protects itself from undue risk. Tarik has a rider on his disability policy that guarantees than he has the option to purchase additional disability income coverage every three years up to age 45. What kind of rider does Tarik have? - ✔✔ guaranteed insurability rider Rick has a rider to his disability income policy that provides for a monthly payment approximating the amount he might receive from Social Security if he is totally disabled. This benefit is paid as long as he is not receiving Social Security or workers' compensation. This benefit can also be reduced by benefits paid under social insurance. What type of rider does Rick have? - ✔✔ social security rider

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An insured can, by written request to the insurance company, have benefits under a policy paid to - ✔✔ a hospital, a physician, or a surgeon All of the following statements about a Non-Cancelable Policy are true: - ✔✔ - a non-cancelable a&h policy is also called a non-cancelable and guaranteed renewable policy. - the only right to cancel the non-cancelable policy is for non-payment of premiums. - the company cannot increase the premium rate once it has been established for the policy. An insured has an A&H Policy which the insurance company declines to renew at the policy anniversary date. This policy is - ✔✔ an optionally renewable policy. What is a Cancelable Policy? - ✔✔ a policy which the company may cancel at any time by returning the unearned premium An insured has an agreement attached to the policy that alters the coverage provided. This agreement is - ✔✔ a rider

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When ABC Life & Accident Insurance Company allows a policy to continue in force without requiring payment of further premiums because of total and permanent disability, the policy contains - ✔✔ waiver of premium provision Roger's Personal Health Insurance Policy covers his son until age 19. At age 17, his son is involved in a water skiing accident which leaves him permanently unable to work. In this situation, what is the obligation of the insurer with respect to continuing coverage on his son in the future? - ✔✔ as long as roger continues to pay premiums, his son will remain a covered dependent A "free look" provision is set by the statutes of each state. It provides that an insured be able to look over the policy to decide if they want to keep it in force. When does this "free look" period begin? - ✔✔ when the insured receives the policy Which statement best describes the purpose of Accumulations in health insurance policies? - ✔✔ used to encourage insureds to renew their policies successively Which of the following types of health insurance policies can the insurance company cancel at any time? - ✔✔ cancelable

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Which of the following statements about the Ten-Day Free Look Provision in an A&H policy is/are TRUE? - ✔✔ It assures the applicant an opportunity to review the policy at no cost. A GUARANTEED RENEWABLE A&H policy grants the insurance company the right to - ✔✔ change premium rates if all other policies in that class within that state are changed. The Insuring clause of an A&H policy usually states all of the following: - ✔✔ - usually the first clause in the policy - that insurance against loss is provided - that a loss must result directly from stated accidents or sicknesses All of the following statements about the Cancellation provision in an A&H policy are true in that the insurance company: - ✔✔ - is obligated to refund the unearned premium on a short- rate table basis if the policy owner requests the cancellation - must refund the unearned premium on a pro rata - must notify the insured of cancellation in writing within a specified period before the cancellation, which is not less than 5 days.

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According to the Uniform Policy Provisions Law, all of the following make up an insurance policy contract: - ✔✔ - the application - endorsements, if any - attachments, if any Absent fraud on the insured's part, under the Uniform Policy Provisions Law, an insurance policy becomes incontestable after: - ✔✔ 2 years Under to the Uniform Policy Provisions Law, what is the required grace period for insurance policies by payment frequency-weekly, monthly, and all others? - ✔✔ 7, 10, and 31 days According to the Uniform Policy Provisions Law, who decides whether a lapsed insurance policy will be reinstated? - ✔✔ the insurer As provided by the Uniform Policy Provisions Law, which of the following are correct statements about reinstating a health insurance policy once it has lapsed? - ✔✔ - a reinstatement application may be required.

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- the insurer will notify the applicant of whether the policy has been reinstated. - if the insurer does not notify the applicant whether or not the policy has been reinstated, the policy is automatically reinstated 45 days after receipt of past due premium payment. Which of the following is a correct statement about the Notice of Claim provision found in health insurance policies, as provided by the Uniform Policy Provisions Law? - ✔✔ if the policy provides disability income, the insurer can require written notice every six months that the claim is continuing. As provided by the Uniform Policy Provisions Law, if an insurer, upon receiving notice of a health insurance claim, does not provide the claimant with a proof of loss form within 15 days, - ✔✔ the claimant is deemed to have complied with the company's notice requirements. According to the Uniform Policy Provisions Law, if a claimant cannot furnish written proof of loss within 90 days after the loss, for example, in the case of a continuing loss within 90 days, - ✔✔ proof of loss shall be furnished within one year from the date otherwise required. According to the Uniform Policy Provisions Law, other than a claim that involves periodic payments, when must an insurer make payment after receiving proof of loss? - ✔✔ immediately

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According to the Uniform Policy Provisions Law, payments of periodic indemnities, for example, disability payments, must be made: - ✔✔ at least monthly According to the Uniform Policy Provisions Law, if the insured or beneficiary cannot release the insurance company from further liability, for example, when the insured or beneficiary is legally incapacitated or a minor - ✔✔ the company may release the benefits to any relative by blood or marriage who is deemed entitled to the money. According to the Uniform Policy Provisions Law, if an insured or beneficiary cannot release the insurance company from further liability, for example, when the insured or beneficiary is legally incapacitated or a minor, and the company releases the money to a relative deemed entitled, the amount paid cannot exceed: - ✔✔ $1,000 According to the Uniform Policy Provisions Law, which of the following is a correct statement about a living insured receiving benefits under a health insurance policy? - ✔✔ the insurer may require a physical examination as often as is reasonable.

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According to the Uniform Policy Provisions Law, all of the following are correct statements: - ✔✔ - if an insured dies accidentally, the insurer may have an autopsy performed, but state law might prevent this. - if an insurer calls for an autopsy, the company must pay for it. According to the Uniform Policy Provisions Law, in order to give an insurer sufficient time to investigate and validate a claim, an insured may not sue the company within _______ after filing a written proof of loss. - ✔✔ 60 days According to the Uniform Policy Provisions Law, what is the maximum time during which a law suit can be filed against an insurance company? - ✔✔ 3 years after written proof of loss is furnished According to the Uniform Policy Provisions Law, which of the following is true of a revocable beneficiary? - ✔✔ a revocable beneficiary can be changed. When proof of loss has been furnished, periodic benefit payments must be made not less frequently than - ✔✔ monthly

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If an A&H Policy provides any periodic payments contingent on continuing loss, written proof of loss must be furnished by the insured within how many days of the termination of the period for which the insurer is liable? - ✔✔ 90 days same as 19 (6.20) - ✔✔ same as 19 (6.20) Once a policy has been reinstated, there is normally - ✔✔ a 10-day waiting period for sickness coverage. The term "Entire Contract" means: - ✔✔ policy, its endorsements, a copy of the application, if attached, and a copy of any other attached papers. Proof of loss must never be received later than - ✔✔ 1 year from the date otherwise required, unless the insured suffers legal incapacity An insured lists his wife as the beneficiary of the Accidental Death Benefits of his Accident & Health Policy, and has relinquished his right to change that designation. His wife is - ✔✔ an irrevocable beneficiary.

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A health insurance policy will be reinstated within how many days after the insured fills out an application and has been issued a conditional receipt? - ✔✔ 45 days If an insurance company fails to notify an applicant that a reinstatement application was not approved, insurance will be placed back in force within how many days? - ✔✔ 45 days How many days must an insured wait after submission of Proof of Loss before taking legal action against an insurance company? - ✔✔ 60 days The purpose of the Time Limit on Certain Defenses provision is to limit the time during which the - ✔✔ insurance company can challenge the contract because of material misstatements in the application. Under the mandatory provisions, insurance companies must provide for a period of grace of not less than: - ✔✔ 7 days for weekly premium policies

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Kentucky Health

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