Chapter 16 Flashcards
Following a loss, an insured must provide proof of loss to their insurer within how many days?
Within 90 days after a loss or as soon as possible, if incapacitated
What is another name for claims form?
Proof of loss forms
An insurer generally will not reinstate a policy that has been lapsed for more than _____ years.
3
Upon death, any unpaid policy premiums will be deducted from the policy _________.
Benefits
How many days does an insurer have to reinstate a lapsed policy?
An insurer has 45 days to decide about reinstating a policy
When does the 10-day free look period begin?
On the day the policy is delivered to the policyowner
What needs to be provided to an insurer in order to reinstate a lapsed policy?
Reinstatement requires all back premiums, interest, and evidence of insurability
What type of policy may be cancelled anytime, for any reason, with proper notification?
A cancelable policy
Only the ________ may change the name of the beneficiary.
Policyowner
Which clause is a summary of the entire contract and is usually the first or face page of the contract?
The insuring clause
A grace period is _______ days and coverage _____ provided during this period.
31; provided
If an insured has multiple policies covering the same medical loss, what is the maximum benefit payable by all policies?
Regardless of the number of policies, no more than 100% of the claims (loss) will be paid
What renewability provision does not allow for premium increases, policy cancellation, or modifications?
The noncancelable provision
What are the different premium payment modes?
Annual, semiannual, quarterly or monthly
Being involved in an illegal activity may result in the _________ of a claim.
Denial
If two or more family members are injured in a common accident, generally only _____ deductible will apply.
One
Define preexisting condition.
A medical condition that was known to exist prior to the policy application
For how long may and insurer contest the validity of a claim based on false application information?
For a maximum of 2 years following the issuance of the policy
What constitutes the entire contract?
The policy, the application (or copy) and any riders, waivers, or exclusions to the contract
All policies sold must conform to the state law in which the policy is ________ and _____________.
Sold; delivered
Unless assigned to another party, who is entitled to receive medical benefits?
The insured policy owner
What is the name for the period of time following a policy premium due date?
The grace period
What renewability provision allows for class based premium increases, but does not allow insurers to cancel contracts?
Guaranteed renewability
The least expensive premium mode is ____________, while the most expensive mode is ____________.
Annual; monthly
How often may a disability payment be paid?
Not more often than monthly
Who pays for the cost of a medical exam?
The insurer
What is an owners right?
The right to change premium mode or beneficiary, assign benefits, receive dividends, or borrow from cash value
What would constitute proof of loss?
Medical bills, doctor statements, and completed claim forms
Claim forms must be provided to an insured within _____ days following the form request.
15
An ___________ beneficiary may not be changed without beneficiary permission.
Irrevocable
If an insured changes to a less hazardous occupation, his premium could go _______.
Down
The __________ is the first beneficiary entitled to receive policy benefits.
Primary
An insured must notify her company that she has suffered a loss within ______ days after the loss occurs.
20
Medical claims must be paid ___________ upon verification of legitimacy.
Immediately
When may an insured being legal action against her insurer?
Between 60 days and 3 years from the denial of a claim.
If an insured changes to a more hazardous job and is injured, what recourse does an insurer have?
Changing to a more hazardous job without giving notice allows the insurer to decrease benefits paid
The __________ Beneficiary is second in line to receive policy benefits, the ________ is third.
Contingent; tertiary
The free look provision may also be called:
The 10-day right to examine
Describe coordination of benefits.
When individuals with more than one benefit plan combine their benefits coverage payment without exceeding actual bill
