Health provisions and concepts

Under an any-occupation definition of total disability, when is the insured totally disabled?

Ruby has a cancelable health policy. The insurer cancels it while she has a claim in progress. How is that claim treated?

Sergei has already met his deductible this year. His plan pays 70 percent of covered expenses. He has a $2,400 covered bill. How much does he pay?

A covered office visit has an allowed amount of $180. Paolo's plan charges a $25 copayment and no other cost sharing for the visit. How much does the plan pay?

Hadley has a basic medical plan plus a supplementary major medical plan with a $500 corridor deductible and 80 percent coinsurance. Her covered bill is $8,000, and the basic plan pays $3,000. How much does the major medical plan pay?

Ezra has a severe developmental disability and depends on his parents for support. He reaches the plan's limiting age for dependents. Under the standard handicapped dependent child provision, what happens?

Which charge is generally NOT an eligible expense under a major medical plan?

Emeka's disability income policy has a guaranteed insurability rider. What does it allow him to do?

Which part of a health policy states the insurer's promise to pay and the scope of the coverage?

A health policy lets the insurer refuse to renew it on any policy anniversary or premium due date, for any reason. What type of renewability is this?

Teodoro can do some of his job duties but not all of them after an injury. Which disability definition fits, and what does it usually pay?

Eitan's plan uses a per cause deductible. How often must he pay the deductible?

Nadia buys an ACA-compliant individual major medical plan. She has had asthma for years. How must the plan treat her asthma?

What is a preexisting condition in health insurance?

Hana compares paying her health premium monthly instead of annually. What is usually true?

Grace pays the premiums on her individual disability income policy with her own after-tax money. How are her premiums and benefits taxed?

Rania owns an accident policy with a revocable beneficiary. What does she need to change the beneficiary?

After receiving notice of a claim, how long does the insurer have under the standard provision to send claim forms to the claimant?

Under the entire contract provision of a health policy, what makes up the contract?

While a disability claim is pending, the insurer asks Thandiwe to see a doctor it chooses. Under the standard provision, who pays for the exam?

Marcus filed proof of loss on March 1 and his claim has not been paid. Under the standard legal actions provision, when is the earliest he may sue the insurer?

Under the payment of claims provision, to whom is a loss-of-life benefit paid when no named beneficiary is living?

Under the standard proof of loss provision, how soon after a loss must written proof of loss normally be filed?

Owen's lapsed health policy was reinstated on May 1. On May 3 he breaks his leg in a fall. Is the injury covered?

Ana's disability benefits from all of her policies add up to more than she earned before she became disabled. Her policy has the relation of earnings to insurance provision. What may the insurer do?