Accident and Sickness Policy Provisions, Clauses, and Riders

Question 1

a beneficiary who has vested interest in the policy and therefor, the policyowner may not exercise certain rights without the consent of the beneficiary

Answer 1

Irrevocable Beneficiary

Question 2

Relinquishment of a right or interest

Answer 2

Waiver

Question 3

developed by the NAIC , established standard provisions that are to be included in all individual health policies

Answer 3

Uniform individual accident and sickness policy provisions law

Question 4

spells out the insureds duty to provide the insurer with reasonable notice in the event of a loss

Answer 4

notice of claim

Question 5

How many days is a notice of claim needed?

Answer 5

20 days

Question 6

After a loss occurs, the claimant must provide ___ in ___ days

Answer 6

prrof of loss, 90

Question 7

How long must the insured wait to take legal action?

Answer 7

60 days

Question 8

identifies the insured and the insurance company and states what kind of loss is covered

Answer 8

Insuring Clause

Question 9

a specified dollar amount beyond which the insured no longer participates in the sharing of expenses

Answer 9

stop-loss limit

Question 10

provision which applies when more than one family member is injured in a single accident

Answer 10

common accident provision

Question 11

medical expenses covered by a health insurance plan

Answer 11

eligible expenses

Question 12

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

Answer 12

usual/reasonable/customary

Question 13

a rider used to exclude coverage for specifically defined pre-existing conditions

Answer 13

impairment rider

Question 14

the one rider that does not call for extra money on premiums

Answer 14

impairment

Question 15

similar to noncancellable provision, but insurer can change premiums on anniversary date

Answer 15

guaranteed renewable

Question 16

an insured purchase a nonancellable health insurance policy one year ago. What would NOT be a reason for the company to cancel the policy?

Answer 16

the insured is in an incident and incurs a large claim

Question 17

A guaranteed renewable disability insurance policy …

Answer 17

is renewable at the insureds option to a specified age

Question 18

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?

Answer 18

time of payment of claims

Question 19

what is NOT a feature of a guaranteed renewable provision

Answer 19

the insurer can increase the policy premium on an individual basis

Question 20

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

Answer 20

usual, customary, reasonable

Question 21

Who has the authority to make changes to an insurance policy?

Answer 21

Insurers executive officer

Question 22

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?

Answer 22

10 days

Question 23

The insuring clause of a disability policy usually does not state

Answer 23

the method of premium

Question 24

how soon following the occurence of a covered loss mustan insured submit written proof of such loss to the insurance company

Answer 24

within 90 days or as soon as reasonably possible, but not to exceed one year

Question 25

A guaranteed renewable policy health insurance policy allows the

Answer 25

policy holder to renew the policy to a stated age, with the company having the right to increase premiums to on the entire class