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IL Life and Health Insurance > Accident/Health Policy Clauses > Flashcards

Accident/Health Policy Clauses Flashcards

1
Q

Renewable at Insurer’s Option

A

Insurer is not obligated to renew the policyholder or keep premiums the same if person becomes ill

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2
Q

Renewable at insurer’s option cannot be cancelled for…

A

Bad health during the policy period

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3
Q

Conditionally Renewable

A

Insurer can’t non-renew due to health but might non-renew for other changes in the person’s level of risk

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4
Q

Guaranteed Renewable

A

Policyholder can renew and can’t be charged more at renewal due to personal health

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5
Q

Where is guaranteed renewable most common?

A

Medical insurance

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6
Q

Can increases happen in guaranteed renewable?

A

Yes, non-discriminatory

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7
Q

Non-cancelable

A

Policyholder can renew and can’t be charged more for any reason unless increases were specifically scheduled in the policy language

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8
Q

Where is non-cancelable possible?

A

Disability insurance and valued policies

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9
Q

Some products might only be guaranteed renewable or non-cancelable until when?

A

Certain age, typically 65

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10
Q

Probationary Period: Individual

A

Might delay coverage for illness (not accidents) for 15 or 30 days after policy issued

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11
Q

Probationary Period: Group

A

Might delay the ability to enroll in a group plan for one or several months

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12
Q

Mandatory Provisions

A

Must appear in all accident/health policies sold to individuals

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13
Q

Mandatory Provisions protect…

A

Consumers

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14
Q

Optional Provisions

A

Don’t need to be included but, when used, can’t be less consumer-friendly than set by law

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15
Q

Optional provisions protect…

A

Insurers

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16
Q

Entire Contract is what kind of provision?

A

Mandatory

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17
Q

Contract between consumer and insurer consists only of…

A

Policy, application, and other documents literally attached to the policy (riders)

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18
Q

Changes to the entire contract must be…

A

In writing and require insurance company’s official sign off (not just agent)

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19
Q

Incontestable Clause is what kind of provision?

A

Mandatory

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20
Q

Incontestable Clause: Insurer has how many years to rescind coverage based on inaccurate application info?

A

2 years

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21
Q

Incontestable Clause: Insurer can still rescind, deny, or cancel coverage based on…

A

Lies related to claims

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22
Q

What kind of provision is a grace period?

A

Mandatory

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23
Q

Grace Period

A

Keeps insurance from lapsing is premiums aren’t paid

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24
Q

Grace Period: Insurer may need to pay if losses occur during grace period but…

A

Can deduct unpaid premiums from settlement

25
Q

Grace Period: weekly payments

A

7 days

26
Q

Grace Period: monthly payments

A

10 days

27
Q

Grace Period: annual or other payments

A

31 days

28
Q

What type of provision is a reinstatement?

A

Mandatory

29
Q

Reinstatement

A

Insured may be allowed to regain individual health insurance by paying 60 days over overdue premium and completing new application

30
Q

Reinstatement: Insurer often has how many days to reject applicant?

A

45 days

31
Q

Reinstatement: If no action is taken in 45 days, what does that mean?

A

Person is covered

32
Q

What kind of provision is a claims provision?

A

Mandatory

33
Q

Notice of claims must be provided to the insurer within how many days?

A

20 days

34
Q

Insurer must provided “proof-of-loss” forms within how many days?

A

15 days

35
Q

Insured must return proof-of-loss forms within how many days of loss?

A

90 days

36
Q

Upon receiving proof of loss, insurer must…

A

Pay within a reasonable time

37
Q

Benefits due at regular intervals MUST be…

A

Monthly

38
Q

What kind of provision is legal action?

A

Mandatory

39
Q

Suits against the insurer can’t be initiated until…

A

60 days after providing proof of loss and must be within 3 years

40
Q

What kind of provision is a physical exam or autopsy?

A

Mandatory

41
Q

Insurer has the right to conduct medical exams to determine…

A

Benefit eligibility at own expense

42
Q

Insurer has the right to an autopsy in cases of…

A

Alleged accidental death from injury, not illness

43
Q

What kind of provision is unpaid premiums?

A

Optional

44
Q

If consumer hasn’t paid all premiums, unpaid amounts can be deducted from…

A

Insurance Settlement

45
Q

What kind of provision is conformity of state statutes?

A

Optional

46
Q

Conformity of State Statutes

A

Coverage will adjust automatically if required by state law

47
Q

What kind of provision is misstatement of age or gender?

A

Optional

48
Q

If incorrect age or gender…

A

Benefits will be adjusted accordingly

49
Q

Adjustments can still occur even if…

A

2 year contestability period has expired

50
Q

What kind of provision is change of occupation?

A

Optional

51
Q

Change of Occupation

A

Applies to disability insurance when insured is doing different job than at a time of application

52
Q

If a more hazardous job…

A

Benefits can be reduced

53
Q

If a less hazardous job…

A

Benefits will be unchanged but some premium can be refunded

54
Q

What type of provision is earnings to insurance?

A

Optional

55
Q

Earnings to Insurance: Clarifies that disability can never be…

A

Greater than income immediately prior to disability OR average income over 2 years prior to disability, whichever is greater

56
Q

Earnings to Insurance: Applies even if insured has…

A

Multiple policies

57
Q

What kind of provision is illegal occupation?

A

Optional

58
Q

Illegal Occupation

A

No coverage while hurt during illegal activity

IL Life and Health Insurance (29 decks)

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