Texas General Lines — Life, Accident, Health and HMOHealth InsuranceEasy
A health insurance policy includes a provision that states the policy will not cover losses incurred as a result of an insured's intentional self-inflicted injury. This is an example of which type of policy provision?
- AIncontestability clause
- BExclusion
- CReinstatement provision
- DGrace period
Show answer & explanationAnswer & explanation
Correct answer: B. Exclusion
Exclusions specify conditions or circumstances for which the policy will not provide benefits. Intentional self-inflicted injury is a common exclusion in health insurance policies.
Why the other options are wrong
- A. The incontestability clause limits the insurer's ability to deny claims based on misrepresentations after a certain period.
- C. A reinstatement provision outlines the conditions under which a lapsed policy can be put back in force.
- D. A grace period is a period after the premium due date during which the policy remains in force.
Exclusion (Health Insurance)
A provision in a health insurance policy that specifies conditions, events, or circumstances for which the policy will not provide coverage or pay benefits.
- Limits the scope of coverage.
- Common exclusions include intentional self-inflicted injury, acts of war, and pre-existing conditions (subject to regulations).
- Clearly stated in the policy document.
Memory trick: Provisions are the policy's rules, exclusions are the 'no-go' zones.