意外与健康保单条款第 344 / 716 题
A 'pre-existing condition' provision in a health policy generally allows the insurer to:
a.Limit or exclude coverage for a condition the insured had before the policy took effect, for a stated period
b.Refuse to ever pay for accidents, including injuries that occur long after the policy took effect
c.Increase the death benefit payable for illnesses the insured was treated for before applying
d.Cancel the policy outright whenever the insured files any claim, regardless of when the condition first arose
解析
A pre-existing condition provision lets the insurer limit or exclude benefits for a medical condition that existed (was diagnosed or treated, or would have prompted a prudent person to seek care) before the policy's effective date, typically for a defined waiting period after which the condition is covered. It is not a general right to cancel the policy whenever a claim is filed, and it does not let the insurer refuse all accident coverage. Health policies pay medical or disability benefits, not a death benefit, so raising a death benefit for previously treated illnesses is inapplicable.
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同考点相关题目
- 一家加州健康保险公司拒赔已承保的服务。下列哪项最佳描述被保险人的「理赔申诉权」?
- 当加州健康保险公司未在法定期限内(一般纸质 30 个工作日 / 电子 30 个日历日)支付或抗辩合规提交的「clean claim」时,对保险公司的主要财务后果是?
- Under the Uniform Provisions Law, the 'time limit on certain defenses' (incontestability) provision in an individual health policy generally prevents the insurer, after the policy has been in force for a stated period, from:
- The mandatory 'notice of claim' provision requires the insured to notify the insurer of a claim within:
- Under the 'claim forms' provision, if the insurer fails to furnish claim forms within the required time (usually 15 days) after receiving notice of claim, the insured may:
- The mandatory 'proof of loss' provision generally requires the insured to submit proof of loss within:
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审核人 John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — 核实)