According to the Mandatory Uniform policy Provisions what is the maximum amount of time

The policy, a copy of the application, any riders and policy endorsements constitute the _____ _____.
A) Entire contract
B) Legal actions
C) Time limit
D) Whole policy

Answer A is correct.
The Entire Contract Provision (a Mandatory Uniform Provision) stipulates that the policy, a copy of the application and any riders constitutes the entire contract between the insurer and insured.

Notice of claim is required within _____ days of loss.
A) 90
B) 15
C) 20
D) 10

Answer C is correct.
The insured under the Notice of Claim Provision (a Mandatory Uniform Provision) is required to notify the insurer, in writing, within 20 days of any loss.

Proof of loss is required within _____ days of loss.
A) 45
B) 180
C) 60
D) 90

Answer D is correct.
The Proof of Loss Provision (a Mandatory Uniform Provision) stipulates the insured is to prove their loss within 90 days of the loss, or in the shortest time possible, but not to exceed 1 year unless the insured suffers legal incapacity.

Which of the following is not a Mandatory Uniform Provision?
A) Payments of Claims
B) Reinstatement
C) Conformity with State Statutes
D) Physical Exam & Autopsy

Answer C is correct.
Conformity with State Statutes is an Optional Uniform Provision.

Harry was hospitalized in a coma for 6 months. Since no one knew about his health care coverage, when does proof of loss have to be submitted?
A) Within 1 year, unless he suffers legal incapacity.
B) Anytime, since he was in a coma and obviously could not submit a claim.
C) Within 2 years, covered under the contestable period.
D) An executor would be appointed by the courts to handle the necessary paperwork.

Answer A is correct.
The Proof of Loss Provision (a Mandatory Uniform Provision) stipulates the insured is to prove their loss within 90 days of the loss, or in the shortest time possible, but not to exceed 1 year unless the insured suffers legal incapacity.

Does the insured have the right to change beneficiary designations?
A) No, because there are no beneficiary designations in health policies.
B) Yes, unless the beneficiary is irrevocable.
C) Yes, there is no such thing as irrevocable in health insurance contracts.
D) No, only the insurer may request changes.

Answer B is correct.
The Change of Beneficiary Provision (a Mandatory Uniform Provision) establishes the insured's right to change the beneficiary, unless irrevocable.

Which statement is inaccurate regarding the Change of Occupation Provision?
A) Change to a less hazardous occupation, insured may apply for a rate reduction.
B) Change to a more hazardous occupation, upon claim, benefits will be reduced to that which premiums paid would have purchased at the more hazardous occupation.
C) Insured must notify the insurer of a change of occupation, or policy will be cancelled.
D) If the insured works at two occupations, rates for the most hazardous occupation will be charged.

Answer C is correct.
Failure to notify the insurer of a change of occupation will not result in cancellation of the policy.

Optional Uniform Provisions are included in the contract at the _____ option.
A) Insured's
B) Insurer's
C) Commissioner's
D) No one's option, they are regulated by statute.

Answer B is correct.
The Optional Uniform Provisions are included at the insurer's option; however, if used they must conform to that state's Insurance Code.

If liability is denied due to the insured being intoxicated or under the influence, it is because of which provision?
A) Legal Actions
B) Illegal Act
C) Conformity with State Statutes
D) Intoxicants and Narcotics

Answer D is correct.
Intoxicants and Narcotics (an Optional Uniform Provision) allows the insurer the right to deny liability if the insured is under the influence or intoxicated at the time of loss.

Albert owns a printing business in which he, at times, prints counterfeit money. One day while processing funny money, his arm was severely damaged. His insurance will:
A) Not pay since he was involved in an illegal act at the time of injury.
B) Pay as he was injured on equipment normally used for legal purposes.
C) This is classified as a Workers' Compensation claim.
D) Will pay but will cancel his contract when he is convicted of the crime.

Answer A is correct.
Illegal Occupation/Act (an Optional Uniform Provision) allows the insurer the right to deny liability if the insured is injured while performing an illegal occupation or committing an illegal act.

Three years ago, Charles purchased a health policy from the QRS Company; he has purchased two additional contracts from the same insurer since. Each contract contains the Other Insurance With This Insurer Provision. What happens if Charles has a claim?
A) Only one policy will pay, the premiums for the other contracts will be returned.
B) Each contract will pay in direct proportion to the loss.
C) Benefits are paid in full by all contracts.
D) The insurer will cancel all contracts because of intent to defraud.

Answer A is correct.
Other Insurance With This Insurer (an Optional Uniform Provision) stipulates that if the insured has more than one policy of the same type with the same insurer, the insured may elect the policy to be used, and excess premiums for the excess coverage will be returned.

Louise purchased a disability policy when her salary was $4,000 a month. Later, she lost that job and her salary was reduced to $2,000 a month. Three years ago, she became self-employed and now receives $3,500 a month. The maximum disability benefit she might expect will be based on which salary amount?
A) $2,000
B) $4,000, the contract amount
C) The average of her income over the life of the contract
D) $3,500

Answer D is correct.
Relations of Earnings to Insurance (a Optional Uniform Provision) establishes that disability benefits shall not exceed the monthly earnings of an insured at the time the disability commenced, or his/her average earnings for the 2 years immediately preceding a disability, whichever is greater.

If an insurer cancels a contract, a written notice must be provided within 5 to 31 days. The contract must have which of the following provisions?
A) Legal Actions
B) Conformity with State Statutes
C) Entire Contract
D) Cancellation

Answer D is correct.
Cancellation (an Optional Uniform Provision) establishes that the insurer may cancel, with written notice of 5 to 31 days, to the insured.

Hank has medical coverage to age 70. He submits a claim for hospitalization. The insurer discovers Hank is actually 73, when his contract states he is 68. What will the insurer do?
A) The insurer must prove fraud to be relieved from making payments.
B) The insurer must refund the excess premiums Hank paid after his 70th birthday.
C) The insurer pays what the premiums would have purchased at the correct age.
D) The insurer must pay the claim, and then cancel the contract.

Answer B is correct.
Misstatement of Age (an Optional Uniform Provision) stipulates that since the misstatement of age led the insurer to provide coverage beyond the age limit, liability is limited to a refund of premiums.

If an insurer makes a payment for a claim but you are dissatisfied, you must wait _____ days after proof of loss before you might take any legal action.
A) 60
B) 90
C) 45
D) 20

Answer A is correct.
According to the Legal Actions Provision (a Mandatory Uniform Provision), the insured must wait at least 60 days after proof of loss before legal action can be brought against the insurer.

An insurer has the right to request a physical exam or an autopsy to determine the entitlement to benefits. The request is at the insurer's expense, due to which provision?
A) Intoxicants and Narcotics
B) Proofs of Loss
C) Physical Exam & Autopsy
D) Proof of Disability or Death

Answer C is correct.
According to the Physical Exam and Autopsy Provision (a Mandatory Uniform Provision), the insurer, at their own expense, has the right to request a physical exam or autopsy where not prohibited by law.

Susan neglected to make her premium payment and she was injured in an accident. After she submitted the claim, she discovered that the insurer had subtracted $200 (the amount of premiums) from the claim. The insurer may do this because of which provision?
A) Unpaid Premiums
B) Grace Period
C) Reinstatement
D) Payment of Claims

Answer A is correct.
Unpaid Premiums (an Optional Uniform Provision) allows the insurer the option of deducting unpaid premiums from a claim.

What is the correct sequence of time for the grace period on an individual medical expense policy for each mode of premium?
A) 7 days weekly, 10 days monthly, 30 all others
B) 7 days weekly, 10 days monthly, 31 all others
C) 10 days weekly, 15 days monthly, 31 all others
D) 30 for individual contracts, 31 for group

Answer B is correct.
According to the Grace Period Provision (a Mandatory Uniform Provision), this is the correct sequence.

Which of the following terms and definitions do not match?
A) Noncancellable - guaranteed renewable and guaranteed premium to age 65.
B) Optionally Renewable - renewable only at the option of the insurer.
C) Guaranteed Renewable - guaranteed renewable without proof of insurability.
D) Cancellable - the life of the policy is expressed and cannot be renewed.

Answer D is correct.
The definition is defining Nonrenewable instead of Cancellable.

Which clause in a contract states that Jim is covered by XYZ insurer for a lifetime maximum of $1,000,000, with a schedule of benefits for various expenses?
A) Consideration Clause
B) Entire Contract
C) Free Look Provision
D) Insuring Clause

Answer D is correct.
The Insuring Clause states who is covered, by whom, for how much, and for what period, against what peril.

Abigail has a preexisting condition noted in her new A & H policy. If she submits a claim for this condition within a specified time stated in the contract, what will the insurer do?
A) Reduce the benefits paid.
B) Pay a reduced amount or deny any claim payment.
C) Pay benefits in full.
D) Provide coverage only if this claim is nonoccupational.

Answer B is correct.
Since Abigail's claim occurred during the Probationary Period, the insurer would likely deny any claim outright or at least pay a reduced amount.

Beth has a contract stating she must be disabled for 3 months before benefits will be paid. This is considered the:
A) Probationary Period
B) Elimination Period
C) Grace Period
D) Contingency Period

Answer B is correct.
The Elimination Period is a period of time that must expire after onset of an illness or occurrence of an accident before benefits will be payable.

Insurers include provisions in contracts to help reduce unnecessary claims and the overpayment of claims. Which of the following is not one of those provisions?
A) Concurrent Review
B) Mandatory Second Surgical Option
C) Consideration Clause
D) Ambulatory Services

Answer C is correct.
The other choices are Case Management Provisions designed to contain costs. The Consideration Clause stipulates that the payment of the first premium and statements in the application are the applicant's consideration, and the insurer's consideration is the promise to pay within the contract terms.

Anna has a contract that includes the Non-Emergency Hospital Preauthorization Admissions Provision. For a scheduled hospital stay, she must first get preauthorization through her insurer. If she does not, the insurer may:
A) Reduce her normal benefits.
B) Cancel her contract.
C) Check her out of the hospital.
D) Pay the benefit, but send her a bill for additional premium.

Answer A is correct.
If Anna does not comply with this provision, she may have her normal benefit level reduced.

Which of the following is a Case Management Provision used by insurers to monitor hospital stays?
A) Case Management
B) Concurrent Review
C) Managed Health Care
D) Precertification

Answer B is correct.
Once an insured is admitted to the hospital the insurer monitors the insured's hospital stay to make certain that everything is proceeding to schedule through the Concurrent Review Provision.

Which statement is false?
A) Mandatory Second Surgical Option is when the physician submits claim information prior to treatment, to know in advance if the procedure is covered.
B) Changes in an Accident and Health contract may be completed only with the written consent of the insurer.
C) When an insured owes back premiums but is still within the grace period, the Unpaid Premium Provision commences for claims submitted.
D) A nonoccupational policy pays for injury or illness off the job.

Answer A is correct.
This is describing Precertification as opposed to Mandatory Second Surgical Opinion.

A health policy not conforming to the Uniform Individual Accident and Sickness Policy Provisions Law:
A) Is invalid.
B) May be voided.
C) Will be construed as if it conformed to the Law.
D) The insurer is fined and the policy corrected.

Answer C is correct.
According to the Conformity with State Statutes Provision (an Optional Uniform Provision), any provision on the policy effective date that is in conflict with statutes of the state is automatically amended to meet state requirements.

An application for disability insurance may be altered by:
A) The insurer
B) The Commissioner
C) The agent
D) No one without the applicant's written consent.

Answer D is correct.
Only the applicant may alter statements on the application.

All states have adopted the Uniform Individual Accident and Sickness Policy Provision Law. If an insurer changes any of these provisions, they must make sure it does not:
A) Weaken the application wording.
B) Conform to NAIC requirements.
C) Create a less favorable meaning than the original wording.
D) Cancel the law of large numbers.

Answer C is correct.
The insurer must assure that any variation must be at least as favorable as the original wording and no provision may be deleted.

One of your clients just reinstated their Accident and Health policy. When is coverage effective for sickness and accident?
A) 30 days sickness, immediate coverage for accidents.
B) Immediately for both accident and sickness.
C) 10 days sickness and immediately for accidental injuries.
D) 10 days accident and 48 hours for sickness.

Answer C is correct.
Upon reinstatement, accidents are covered immediately, and sickness is covered after 10 days.

Which of the following is not a Mandatory Uniform Provision of an Accident and Health policy?
A) Payment of Claims.
B) Time limit on certain defenses.
C) Proof of Loss.
D) Waiver of Premium.

Answer D is correct.
Other choices are Mandatory Uniform Provisions. Waiver of Premium is a provision that may or may not be included.

If the insurer cancels an individual health plan, what happens to the unearned premium?
A) It is used to offset underwriting costs.
B) The total is refunded.
C) It is refunded on a short rate basis.
D) It is refunded on a pro rata basis.

Answer D is correct.
According to the Cancellation Provision (an Optional Uniform Provision), if the insurer cancels on the insured, unearned premiums are refunded on a pro rata basis.

Precertification, Mandatory Second Surgical Opinion, and Concurrent Review are provisions in health insurance policies known as:
A) Miscellaneous Provisions
B) Policy Abilities Provisions
C) Case Management Provisions
D) Protect Insurer Provisions

Answer C is correct.
They are included as Case Management Provisions or sometimes referred to as Cost Containment Provisions.

Each Health and Disability Income Policy must express the conditions and provisions for _______.
A) Policy corrections
B) Conditional coverage
C) Refunds of premium at maturity
D) Continuation of the contract

Answer D is correct.
Each policy must express the conditions and provisions for renewal or continuation of coverage.

Which provision is a Mandatory Uniform Provision?
A) Legal Actions
B) Misstatement of Age
C) Conformity with State Statutes
D) Illegal Occupation

Answer A is correct.
The only response that is a Mandatory Uniform Provision is Legal Actions. All other responses are Optional Uniform Provisions.

Which provision states that the insurance company must pay claims immediately?
A) Payment of Claims
B) Legal Actions
C) Relation of Earnings to Insurance
D) Time of Payment of Claims

Answer D is correct.
Time of Payment of Claims (a Mandatory Uniform Provision) stipulates that claims are to be paid immediately upon written proof of loss.

An insured should receive necessary claim forms within _____ days after notice of claim.
A) 5
B) 10
C) 15
D) 20

Answer C is correct.
According to the Claim Forms Provision (a Mandatory Uniform Provision), the insured should receive the necessary claim forms within 15 days after notice of claim.

All are Optional Provisions, except:
A) Illegal Occupation.
B) Legal Actions.
C) Change of Occupation.
D) Misstatement of Age.

Answer B is correct.
Legal Actions is a Mandatory Uniform Provision. All other responses are Optional Uniform Provisions.

Which provision is an Optional Uniform Provision?
A) Claim Forms
B) Other Insurance With This Insurer
C) Physical Examination
D) Payment of Claims

Answer B is correct.
Other Insurance With This Insurer is an Optional Uniform Provision. All other answers are Mandatory Uniform Provisions.

The Guaranteed Renewable Provision states:
A) Renewable with adjustable premiums determined by frequency of claim.
B) Renewable with guaranteed premium.
C) Renewable with adjustable premiums, by classification only.
D) Renewable only at the option of the insurer.

Answer C is correct.
The Guaranteed Renewable Provision does allow the insurer to adjust premiums upon renewal, but by classification only, not by individual.

Managed Health Care attempts to contain health care costs by controlling the behavior of participants through all of the following, except:
A) Unlimited access to providers.
B) Comprehensive case management.
C) Preventive care.
D) Risk sharing.

Answer A is correct.
Managed Health Care attempts to contain health care costs by controlled access to providers as opposed to unlimited access.

The Legal Actions provision preserves the insured's right to bring suit against their own insurer, but the insured must wait at least _____ days before pursuing this action after they have filed a proof of loss?
A) 30
B) 45
C) 60
D) 90

Answer C is correct.
The insured must wait at least 60 days following the filing of a proof of loss before pursuing any legal action(s) against the insurer.

The Insuring Clause under an individual A&H policy would contain all the following, except:
A) The name of the insured and insurer.
B) What perils are covered.
C) The length of the policy period.
D) Premium or rate calculations.

Answer D is correct.
Premium or Rate consideration would be part of the Consideration Clause. All other possible answers would all be a part of the Insuring Clause.

Kirk has just reinstated an individual A&H policy that had lapsed and wants to know how soon coverage will be in effect for any accident or sickness. You, the agent, would say:
A) Accidents immediately, sickness after 10 days.
B) Accidents immediately, sickness after 30 days.
C) Sickness immediately, accidents after 10 days.
D) Sickness immediately, accidents after 30 days.

Answer A is correct.
Upon reinstatement, accidents are covered immediately, and sickness after 10 days. This avoids the motivation to attempt reinstating a policy once an insured is already sick.

When an insurance company cancels a policy, the unearned premium is
A) Retained in full to cover expenses.
B) Returned in full to the insured in a pro rata return.
C) Returned in part to the insured in a short rate return.
D) Paid into the state insurance guarantee fund, and in some cases returned to the insured.

Answer B is correct.
When the insurance company cancels a policy, the unearned or unused premium is returned in full in a Pro-Rata return, which is All Unused premium.. When the insured cancels, the unearned premium is returned Short-Rate, which is Pro Rata - Short administrative costs.

What is the grace period on a monthly premium health plan?
A) 7 Days
B) 10 Days
C) 31 Days
D) 60 Days

Answer B is correct.
In Health Insurance, Grace Periods are: 7 Days for Weekly, 10 Days for Monthly, and 31 Days for all other modes.

With written consent, an insured can allow the insurance company to release funds to
A) Anyone they want.
B) Themselves only.
C) Doctors, hospitals or surgeons.
D) The insured's beneficiary.

Answer C is correct.
This is called: Assignment: which redirects policy benefits from the policyowner to the health care provider.

Under the unpaid premium provision, if an insured owes a past due premium payment at the same time a claim is filed,
A) The insurer will not pay the claim until the premium is paid.
B) The insurer is excused from paying the claim even after the premium is paid.
C) The insurer may deduct the amount of the premium from the claim paid.
D) The insurer must pay the full claim, and continue to attempt to collect the premium as if no claim were due.

Answer C is correct.
The Unpaid Premium Provision allows the insurer to deduct the premium from the claim if the claim is filed in the grace period.

Health policies are considered incontestable after
A) One year.
B) Two years.
C) Three years.
D) Five Years.

Answer B is correct.
Time Limit on Certain Defenses, Aka: Incontestability is 2 years for Health Policies.

When an insurance company cancels a policy, the unearned premium is
A) returned to the insured on a short rate basis.
B) returned in full to the insured in a pro rata return.
C) not available at all.
D) returned to the state insurance department and then forwarded to the insured upon request.

Answer B is correct.
The full amount of the unearned premium must be returned to the insured when the insurer cancels an insurance policy and is considered to be returned on a pro rata basis.

Under the unpaid premium provision, if an insured owes a premium payment at the same time a claim is filed,
A) the insurer will cancel the policy immediately.
B) the insurer will pay the unpaid premium for the insured, then pay the claim as well.
C) the insurer may deduct the amount of the premium from the claim paid.
D) the insured has 90 days from the payment of claim to pay the overdue premium, if not paid the policy will be canceled by the insurer.

Answer C is correct.
The insurer may deduct the amount of the premium form the claim paid. The insurer may choose, but is not required, to pay the claim in full, and accept a promissory note form the insured for payment at some time in the future.

The Other Insurance in this Insurer provision allows an insurer to control
A) deductibles.
B) overinsurance
C) claim payments.
D) coinsurance amounts.

Answer B is correct.
This provision helps an insurer protect against individuals collecting so much insurance that it becomes actually profitable for them to become ill or see a doctor. It prevents the possibility of over insurance occurring.

Camille changes jobs, from file clerk to firefighter. Shortly thereafter, she is injured. Under the change of occupation provision, what will the insurer pay toward her claim?
A) The insurer is required to pay the stated amount in the policy regardless of the change of occupation.
B) The insurer will void the policy due to a change in occupation.
C) The insurer will pay a partial benefit based on the benefit the policy premium would have purchased for an insured in the more hazardous occupation.
D) The insurer will pay an amount equal to 80% of her income as a file clerk only, with no adjustments made due to her new occupation.

Answer C is correct.
The change of occupation provision relieves the insurer from paying benefits not anticipated when the premium was established by reducing the amount of benefit to what the established premium would have bought for an individual in a more hazardous occupation. Benefits are adjusted to premiums collected.

When a policy is reinstated
A) accidents are not covered for one full year.
B) sickness coverage begins immediately, accidents are generally covered within 20 days..
C) accidents and sickness both have a 10 day waiting period after which both are covered automatically..
D) there is a waiting period before sickness coverage becomes effective, but accident coverage becomes effective immediately.

Answer D is correct.
Sickness coverage requires a waiting period, generally 10 days after reinstatement. This is required to keep people from reinstating coverage because of impending medical costs. Accident coverage does not require the waiting period, because accidents are less foreseeable than illnesses.

What constitutes an entire health insurance contract?
A) The application makes up the entire contract.
B) The policy, its endorsements, and any attached papers
C) The policy, a copy of the application and an outline of coverage.
D) The policy, a copy of the application and a copy of the applicants medical records.

Answer B is correct.
The policy, endorsements, and any attached papers make up the entire contract. Outline of coverage, medical records and papers that are not attached are not treated as part of the contract by law. The application by itself does not constitute the entire contract.

How many uniform policy provisions are there?
A) 12
B) 21
C) 23
D) 28

Answer C is correct.
There are 23 uniform provisions. There are 12 required uniform provisions and 11 optional uniform provisions. Some companies refer to Insurance with other insurers, as two provisions, broken down into two categories: pro-rata and/or primary excess. Counted this way, this makes a total of 23 uniform policy provisions altogether for Alabama's state exam.

Optional Provisions 1 and 2, addressing changes of occupation and misstatement of age, permit the insurer to do which of the following?
A) Require the insured to re-apply as a new applicant to correct the applicants information.
B) Void the policy completely.
C) Pay indemnities equal to benefits that would have been purchased at the premium paid had the insurer known the facts when the premium was established.
D) None of the above.

Answer C is correct.
Both of these optional provisions allow the insurer to adjust the claim to reflect the true risk to be covered by the policy. In other words, the claim will be adjusted to that which premiums collected would have purchased, had they known the correct information. If it occurs before a claim is filed, the insurer will simply adjust the premiums according to the new information.

George has a policy that may not be cancelled by the insurer. The insurer also may never raise George's premiums. George's policy is
A) noncancellable.
B) nonrenewable.
C) guaranteed renewable.
D) conditionally renewable.

Answer A is correct.
While the terms noncancellable and guaranteed renewable are often used interchangeably, there is a difference. A guaranteed renewable policy allows premiums to be increased, where as a noncancellable policy may never increase premiums. A nonrenewable and a conditionally renewable policy can be cancelled.

Which of the following accurately describes the free look provision?
A) Allows the insured to look over the issued policy for a specific number of days and return it for a partial refund of premiums paid if desired.
B) Allows the insured to look over the issued policy for a specific number of days and return it for a premium refund if desired.
C) Allows the proposed insured to look over a sample policy prior to completing the initial application for insurance.
D) All of the above.

Answer B is correct.
A free look provision allows the insured to review the issued policy for a specified period, usually 10 days. It requires the insurance company to provide a full refund of premiums paid if the insured is not totally satisfied.

A health insurance policy that the insurer may choose not to renew only on the premium due date is called
A) a non-cancellable policy.
B) a guaranteed renewable policy.
C) an optionally renewable policy.
D) a period of time non-renewable policy.

Answer C is correct.
With an optionally renewable policy the insurer may decide, at their option, not to renew the policy for any reason they decide, but only on the policy anniversary or premium due date.

Second surgical opinions, precertification, concurrent reviews, and outpatient/ambulatory services are elements of a cost containment system commonly known as
A) HIPPA
B) case management.
C) considerations.
D) non-forfeiture options.

Answer B is correct.
Cost Containment in Health Care is commonly referred to as Case Management Provisions. These provisions are meant to try to contain health care costs or to manage the health case file. Its primarily used to help manage health care, control claims and help reduce costs, etc.

When may producers change a policy or waive its provisions according to Required Provision 1?
A) Never
B) Anytime
C) With the authorization of the insurance company.
D) When the insured has authorized the change.

Answer A is correct.
Required Provision 1 Entire Contract states what makes up the contract and who is allowed to make changes in the contract. It states that an agent NEVER has the authority to make any changes to an application or waive any of its policy provisions.

What is the minimum grace period, provided in Required Provision 3, for all policies other than monthly or weekly premium policies?
A) 7 days
B) 10 days
C) 30 days
D) 31 days

Answer D is correct.
Required Provision 3 Grace Periods states that a grace period of 7 days for weekly premium policies, 10 days for monthly premium policies and 31 days for all other policy modes must be granted.

A certain health insurance policy states that the insurer will not refuse to renew the policy and furthermore, the insurer may not cancel the policy. However, the insurer may change the premium by classes of insureds. This policy is
A) a guaranteed renewable policy.
B) a noncancellable policy.
C) a nonrenewable policy.
D) an optionally renewable policy.

Answer A is correct.
A guaranteed renewable policy cannot be canceled or non-renewed, and premiums cannot be increased on an individual basis. Premiums may only be changed by classes of insured's. The insurer cannot single you out and raise only your premiums, they must raise everyone's premiums by classification.

Which of the following is not true concerning the notice of claim and claim forms according to Required Provisions 5 and 6?
A) There is no specified amount of time in which the insured must provide the notice of claim to the insurer.
B) If the insurer fails to send the insured claims forms within 15 days after the insured gives notice of claim, the insured may submit written proof of the loss.
C) Notice to the insurer may be given by a beneficiary of the insured on the insured's behalf.
D) Notice provided to any authorized agent of the insurance company is considered to be proper notification to the insurer.

Answer A is correct.
The insured must file notice of claim within 20 days or as soon as reasonably possible.

Other Insurance with This Insurer, Insurance with Other Insurers, and Relations of Earnings to Insurance are all Optional Provisions which deal with situations where an insured can receive more money from loss of time benefits Disability) than from working , or more for reimbursement of medical expenses than these services actually cost. This is
A) called overinsurance and can be remedied by each insurer's paying proportionate benefits or a single insurer allowing the insured to choose the policy from which benefits will be paid.
B) the purpose of insurance. It will help the insured to profit from and gain as a result of the loss incurred.
C) required to be in a policy to detect fraud, and allows the insurer to void the policy if the insurer discovers that the insured has received more in benefits than the loss that actually occurred.
D) called The Principle of Indemnity which is to allow the insured to profit and gain from the loss incurred.

Answer A is correct.
All of these Optional Provisions are designed to prevent overinsurance. This would violate the Principle of Indemnity which is not to profit-not to gain. The provision: Other Insurance with This Insurer allows the insured to simply choose the policy that they want to pay for the medical expenses. Insurance with Other Insurers indicates whether each insurance company pays proportionately (prorata) towards the medical expenses or on a Primary/Excess basis. Relations of Earnings to Insurance applies to Loss of Time benefits (disability) where an insured can only receive a specified percentage of their normal salary, not to receive more than they received when working.

According to Optional Provision 8, if the insurance company cancels a policy, on what basis must prepaid premiums be returned to the insured?
A) Pro rata basis, which means all unearned premium is returned to the insured.
B) Pro rata basis, which means all unearned premium is returned minus administrative fees and additional charges.
C) Pro rata basis, which means the insurer pro rates the amount of premium it would have earned throughout the remaining policy period and returns the balance minus expenses.
D) Short rate basis, which means the insurer retains all premiums paid and the insured receives no refund at all.

Answer A is correct.
Optional Provision 8 which addresses cancellation of a policy stipulates that if the insurance company cancels the policy, ALL unearned premium, or unused premiums are returned to the insured on a pro-rata basis. If the insured cancels the policy the premiums are refunded on a short rate basis, which is the same as pro rata except they also withhold administrative fees and charges, thus; short rate.

Optional Provision 9, which deals with conformity to state statutes, provides
A) insurance companies the right to request and establish state laws that are helpful to the insurance industry.
B) that policy provisions in conflict with state statutes where the insured resides are automatically amended to conform to the minimum requirements of the law.
C) the insured the right to challenge state statutes when in conflict with policy provisions and make the state legislature conform state laws to accommodate the insureds policy claim proceeds.
D) all of the above.

Answer B is correct.
Optional Provision 9, required in some states, says that any policy provision in conflict with state statutes in the insured's state of residence is automatically amended to conform with the state's minimum legal requirements.

According to Required Provision 11, the insured is prevented from filing suit against the insurer for at least
A) 60 days and not longer than three years from the date of proof of loss.
B) 60 days and not longer than ten years from the date of proof of loss.
C) 90 days and not longer than five years from the date of proof of loss.
D) 90 days and not longer than ten years from the date of proof of loss.

Answer A is correct.
Required Provision 11, Legal Actions states that no legal action against the insurer can be started before 60 days from the date of proof of loss, or up to three years after that same date.

An insured's accident policy uses the phrase accidental bodily injury to define what constitutes accidental injury and/or resulting death. This phrase
A) is more restrictive than the phrase accidental means.
B) is less restrictive than the phrase accidental means.
C) is not used to define an accidental injury.
D) can only be used in Worker's Compensation policies.

Answer B is correct.
Accidental means indicates the accident must be completely unforeseen and unintended, while accidental bodily injury covers virtually all but self-inflicted injuries. Accidental Bodily Injury is less restrictive than Accidental Means.

What is a cancellable policy?
A) A policy written for a short period of time and must be cancelled when the term expires.
B) A policy that may be cancelled but only if specific conditions stated in the policy occur during the policy period.
C) A policy the insurer may cancel at any time by returning the unearned premium.
D) None of the above.

Answer C is correct.
With a cancellable policy, the insurer can cancel the policy at any time as long as the unearned premiums are returned to the insured.

When an insured holds more than one occupation, and occupation is used to classify the risk, the insurer will generally classify the insured according to the occupation
A) that is least hazardous.
B) that is most hazardous.
C) that is considered to be the insured's primary occupation.
D) that the insured is expected to retire from at normal retirement age.

Answer B is correct.
The insurer will rate the risk according the occupation that poses the most hazards and/or risk.

According to Required Provision 2, unless an insured has made fraudulent misstatements, a policy is incontestable after
A) one year.
B) two years.
C) three years.
D) the policy has been issued.

Answer B is correct.
Required Provision 2 Time Limit on Certain Defenses AKA (Incontestable) states that after 2 years from the policy issue date, no statements, except fraudulent statements, can be used to void the policy.

Required Provision 10 indicates that if the insurer wants to have an autopsy performed while a claim is pending, the insurer
A) may do so if it is not forbidden by law and if the insurer pays for it.
B) may do so if not forbidden by law and any costs involved would be deducted from the policy proceeds.
C) may do so regardless of any law forbidding it because the insurer has a right to validate the claim.
D) must have the authorization of the executor of the insured's estate before performing the autopsy.

Answer A is correct.
Required Provision 10 states that the insurer may perform an autopsy at its own expense if it is not forbidden by law.

What are the mandatory uniform policy provisions?

How long does a health insurance policy remain in force?

What is the maximum amount of time after premium due date?

What is the time limit for nonlnfraudulent misstatements in health insurance policies?

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?

What are the mandatory uniform provisions?

What is the maximum amount of time in which an insured must supply written proof of loss to the insurance company?

What is the time limit for the limitations on insurer defense provision?