Accident and Sickness Policy Provisions, Clauses, and Riders Flashcards
a beneficiary who has vested interest in the policy and therefor, the policyowner may not exercise certain rights without the consent of the beneficiary
Irrevocable Beneficiary
Relinquishment of a right or interest
Waiver
developed by the NAIC , established standard provisions that are to be included in all individual health policies
Uniform individual accident and sickness policy provisions law
spells out the insureds duty to provide the insurer with reasonable notice in the event of a loss
notice of claim
How many days is a notice of claim needed?
20 days
After a loss occurs, the claimant must provide ___ in ___ days
prrof of loss, 90
How long must the insured wait to take legal action?
60 days
identifies the insured and the insurance company and states what kind of loss is covered
Insuring Clause
a specified dollar amount beyond which the insured no longer participates in the sharing of expenses
stop-loss limit
provision which applies when more than one family member is injured in a single accident
common accident provision
medical expenses covered by a health insurance plan
eligible expenses
means the insurance company will pay an amount for a given procedure based upon the average charge for that procedure in that specific geographic area
usual/reasonable/customary
a rider used to exclude coverage for specifically defined pre-existing conditions
impairment rider
the one rider that does not call for extra money on premiums
impairment
similar to noncancellable provision, but insurer can change premiums on anniversary date
guaranteed renewable
an insured purchase a nonancellable health insurance policy one year ago. What would NOT be a reason for the company to cancel the policy?
the insured is in an incident and incurs a large claim
A guaranteed renewable disability insurance policy …
is renewable at the insureds option to a specified age
An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?
time of payment of claims
what is NOT a feature of a guaranteed renewable provision
the insurer can increase the policy premium on an individual basis
a medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic are is known as
usual, customary, reasonable
Who has the authority to make changes to an insurance policy?
Insurers executive officer
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
10 days
The insuring clause of a disability policy usually does not state
the method of premium
how soon following the occurence of a covered loss mustan insured submit written proof of such loss to the insurance company
within 90 days or as soon as reasonably possible, but not to exceed one year
A guaranteed renewable policy health insurance policy allows the
policy holder to renew the policy to a stated age, with the company having the right to increase premiums to on the entire class
