Health Insurance Policy Provisions Flashcards
Uniform Individual Accident and Sickness Law
establish standard provisions that must be included in all policies; rules of the insurer and insured
common exlusions
war, intentional self inflicted injuries, maternity (this can be added for additional premium)
renewability proivisions
cancellation policies optionally renewable policies conditionally renewable policies guaranteed renewable policies noncancelable policies
insuring clause
specifies scope and limits of coverage; also determines how services will be paid
consideration clause
initial premium collected, statements made in applications, how much money/how often insured agrees to pay; all ask the insurer to CONSIDER
conversion clause for dependents
dependents are covered so as long as they are 26 years or under or they get married
When reinstating a policy, sickness is covered only after ___ days after reinstatement days to protect against adverse selection
10
When reinstating a policy, sickness is covered only after ___ days after reinstatement days to protect against adverse selection
10
impairment rider/waivers for impairment
when the insurance company does not cover a loss due to a specific condition the insured has
conditionally renewable policy
allow insurers to terminate policy only in the event of one or more conditions as stated in the contract; insurer CAN increase premiums at time of renewal
time limit of certain defense
insurer has 2 years upon initial policy date to fight a claim
cancelable policies
illegal in most states, states insurer can cancel at any time, or increase premiums
nonrenewable policies
policies established for a short period of time, usually less than a year; usually associated with short term health insurance
optionally renewable policies
gives insurer option to terminate policy on date specified in the contract
