Health Insurance Mastery Practice Exam

If Jackie forgets to pay her health insurance premium and suffers a loss, how will the insurer handle her claim?

1. The claim will be denied

2. The claim will be paid fully

3. The claim will be paid with the premium deducted from benefits

4. The claim will be held until the premium is paid

The correct answer is: The claim will be paid with the premium deducted from benefits

If Jackie forgets to pay her health insurance premium and subsequently suffers a loss, the insurer typically handles the claim by paying it but deducting the amount owed for the unpaid premium from the benefits. This means that even though Jackie has experienced a health-related issue, her obligation to maintain premium payments is factored into the insurer's response. This policy is based on the principle that an active insurance policy requires timely premium payments to remain in force. Therefore, upon recognizing that the premium is delinquent, the insurer may still provide coverage for claims arising during that period but will proportionally deduct the premium amount from the benefits. This ensures that while the insured is temporarily behind on payments, they aren’t wholly unfairly penalized for the oversight, yet still emphasizes the importance of maintaining the policy in good standing. In this case, the insurer is essentially balancing the contractual obligation to honor claims with the necessity for the insured to remain compliant with the payment terms of the insurance policy. This approach allows for some level of coverage despite the missed payment, emphasizing the importance of keeping premiums current while also acknowledging the reality of the insured's situation.