Chapter 25 - Individual Health Optional Provisions Flashcards
Optional Provisions
Change of Occupation - only apply to health insurance, not life. requires the insured to notify the company when the insured changes occupations. If the insured does not and files a claims, the company will not deny the claim but lower/or increase the benefits to what the adjusted job benefits, depending if the new job is less or more risky.
Illegal Occupation Provision - company wont pay claims that arise from a pursuit of illegal occupation. The policy will stay in tact, but the claim will not be paid if you got hurt selling drugs.
Intoxicants or Narcotics Provision - may exclude coverage if the accident claim arises from these uses, unless prescribed by a physician. Policy stays in tact and will pay claims outside of this still.
Insurance with Other Insurers - prevents stacking, duplicate policies with different companies they will share a PRO RATA is paying benefits. Stacking is permitted with Life insurance.
Cancellation provision - the insureds right to cancel the policy at any time without affecting any current pending claims.
Conformity with State Statutes Provision - stipulates that language of a Health Insurance contract does not conform to state law. Company cant slip anything that contradicts state law.
Unpaid Premiums Provision - before paying a claim, the insurer may deduct the past due premiums plus interest from the benefits. Grace periods are shorter for weekly (7days) and monthly (10days) for health insurance.
Optional Exclusions - War, military, aviation, self inflicted, felony, pre existing conditions, vision, preventative care, work related accidents, foreign travel, uncomplicated pregnancy and childbirth, drug alcohol addiction, custodial care, lost income.
Exclusion Rider - a way to insure an individual with a pre-existing condition. Group policies are typically covering pre-existing conditions, but for individual it helps those who cant get coverage with pre-existing conditions to get covered for the rest of their health.
ACA no longer permits preexisting conditions for most medical policies. Can still apply to Medicare supplement, long term care, dental, ect.
