A&H Policy ProvisionsQuestion 518 of 716

The insuring clause of a health insurance policy:

a.Names the producer who sold the policy and states the commission the insurer will pay to that producer
b.Sets the schedule of dates on which the policyowner's premiums must be paid to keep coverage
c.States the insurer's promise to pay benefits for covered losses and defines the basic scope of coverage
d.Lists the specific conditions, injuries, and treatments that the policy will not cover and for which no benefits are paid

Explanation

The insuring clause is the insurer's core promise: it states that the insurer will pay benefits for the losses the policy covers and broadly defines the coverage being provided. Listing what is not covered is the function of the exclusions. Setting the premium schedule is a separate provision, and naming the producer is not part of the insuring clause. The insuring clause establishes the fundamental agreement to provide coverage, from which the rest of the policy elaborates.

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PrepPass team · Verified against California Life & Health Insurance License Exam · How we review
Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)
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