Chapter 17-Uniform Individual Health Provisions Flashcards
required by the state because the protect the public from the company
Required Provision
protect the insurance company from the insured but not required
Optional Provision
the entire policy itself, the application and any attachments
Entire Contract & Changes
gives the insurance company 2 years to challenge or contest the information on the application before it becomes incontestible
Time Limit on Certain Defenses
31 day period the insured has to pay the premium after due
Grace Period
after lapse; the company can charge no more than 60 days back premium; insurer has 45 days to accept or reject application; insurer can place a 10 day waiting period for sickness
Reinstatement
insured given at least 20 days to inform the insurer of a claim or as soon as reasonably possible
Notice of claim
insurer has ______ days to provide claim forms to the insured once notice of claim is received
15
insured has 90 days after the date of loss to submit
Proof of Loss
claims must be paid within ______days
60 (time of payment of claims)
specifies to whom the claims should be paid
Payment of claims
allows the insurer the right and opportunity to examine the insured at their expense
Physical Exam & autopsy
insured must allow the insurer 60 days after filing a written proof of loss, before any action can be instigated against the insurance company
Legal Action
the right designate and change the beneficiary designation
Change of Beneficiary
written to protect the insurer in the event that the insured changes occupation while the policy is in effect
Change of Occupation
the benefit will be adjusted to provide a benefit based upon what the premium paid would have purchased at the correct age
Misstatement of age
the insurer will pay no more than the benefit the insured qualifies for; any excess coverage will be refunded.
Other Insurance
insurer will not pay a benefit that exceeds the average earnings (24 month avg)
Relation of Earnings to Insurance
allows unpaid Premium to be deducted from any amount owed
Unpaid Premium
if the insurer cancels the policy a refund is paid on this basis
Pro Rata Refund
keeps the insurer and wording of the contract league with the state
Conformity with State Statues
insurer will not be responsible for any loss to which a contributing cause was the insured’s commission or attempt to commit a felony
Illegal Occupation
insurer will not be responsible for any loss sustained as a result of the insured’s being under the influence
Intoxicant and Narcotics
