Illinois Health Insurance Practice Exam

What is the purpose of the optional provision, Misstatement of Age, in health insurance policies?

1. To increase premiums

2. To maintain benefits regardless of age

3. To reduce benefits to match actual age and sex

4. To offer additional coverage for older individuals

The correct answer is: To reduce benefits to match actual age and sex

The purpose of the optional provision, Misstatement of Age, in health insurance policies is primarily to ensure that benefits provided align with the insured's true age and gender. When the age of the insured is misstated, this provision allows the insurer to adjust the benefits to match what the premiums would have provided had the correct age been known. This maintains fairness in the insurance contract by ensuring that the coverage corresponds appropriately to the risks associated with the actual age of the policyholder. When an individual underreports their age to pay lower premiums, the insurer reserves the right to reduce benefits accordingly if a claim arises. This way, the policy remains equitable for both the insurer and the insured, reflecting the risk associated with the accurate age. The other options suggest changes in premiums, maintaining benefits regardless of actual age, or providing additional coverage, none of which accurately capture the primary function of the Misstatement of Age provision. Thus, the provision is vital for aligning the policy terms with the realities of the policyholder’s demographics.