California Life and Health Insurance Practice Exam

What term describes the provision under a health insurance policy that outlines the kind of benefits provided?

1. Coverage clause

2. Insuring clause

3. Exclusion clause

4. Deductible clause

The correct answer is: Insuring clause

The insuring clause in a health insurance policy is the specific provision that details the benefits that the insurer will provide to the insured. It defines the scope of coverage, specifying which medical services and treatments are included under the policy. This clause is crucial for understanding the extent of the financial protection offered by the insurance plan, as it clearly sets forth what is covered and under what circumstances. In contrast to the insuring clause, a coverage clause might sound relevant but typically is a term that can refer more generally to any statement regarding coverage. The exclusion clause outlines what is not covered by the policy, providing limitations and exceptions that protect the insurer from claims related to certain conditions or situations. The deductible clause pertains to the amount that the insured must pay out-of-pocket before coverage kicks in, which is a financial responsibility rather than a description of benefits. Overall, the insuring clause is fundamental in establishing the agreement between the insurer and the insured regarding the type of benefits provided, making it the correct choice in this context.