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Claims & Benefits: Life and Health Insurance License Exam

Master the essential Claims & Benefits concepts tested on the Life and Health Insurance License Exam. These 24 flashcards cover claims procedures, benefit calculations, exclusions, and payout options critical for exam success. Perfect for insurance students seeking a comprehensive review of how policies pay out and what conditions apply.

24 cards Intermediate Claims Procedures Life Insurance Benefits Health Insurance Benefits Exclusions & Limitations Benefit Settlement Options

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Preview Questions

Question 1

What is the standard timeframe within which an insured must provide written notice of a claim to the insurer after a loss occurs?

Answer

The insured must provide written notice of a claim within 20 days after a loss occurs, or as soon as reasonably possible.

Question 2

After receiving notice of a claim, within how many days must an insurer furnish claim forms to the insured?

Answer

The insurer must furnish claim forms within 15 days of receiving notice of a claim.

Question 3

What is the standard deadline for submitting proof of loss to an insurer for a health insurance claim?

Answer

Proof of loss must typically be submitted within 90 days after the date of loss, or as soon as reasonably possible.

Question 4

If an insurer does not provide claim forms within the required timeframe, what right does the claimant have?

Answer

The claimant may submit proof of loss in any written form that describes the occurrence, character, and extent of the loss.

Question 5

What is the 'time of payment of claims' provision in health insurance, and how quickly must benefits be paid?

Answer

The time of payment of claims provision requires that benefits be paid immediately upon receipt of written proof of loss, or periodically (e.g., monthly) for ongoing claims.

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