Question

James is covered with health insurance by two different insurers. The "insurance with other insurers" provision in an individual health insurance policy allows an insurer to pay benefits to the insured on a pro-rata basis when:

A) The insured files a claim with both insurers simultaneously.
B) The insured has pre-existing conditions.
C) The insured has not paid the premiums on time.
D) The insured has coverage with multiple insurers for the same loss.

Answer 1

The "insurance with other insurers" provision allows an insurer to pay benefits to the insured on a pro-rata basis when the insured has coverage with multiple insurers for the same loss.

Step-by-step explanation:

The "insurance with other insurers" provision in an individual health insurance policy allows an insurer to pay benefits to the insured on a pro-rata basis when the insured has coverage with multiple insurers for the same loss. This means that if James has health insurance from two different insurers and files a claim for the same medical expenses, both insurers will share the cost of the claim based on the proportion of coverage they provide. For example, if Insurer A covers 60% of the medical expenses and Insurer B covers 40%, they will pay those respective percentages of the total claim amount. This helps prevent the insured from receiving more than the actual cost of the loss.