Health Insurance Policy Provisions Flashcards
Entire contract provision
The insurance policy represents a contract between the insurer and insured and consists of:
-application
-insurance policy
-riders (endorsements)
Grace period is ____ days for weekly premium health policies
7
Grace period is __ days for monthly premium health policies
10
Grace period is __ days for all other mode premium health policies (annually, semiannually, or quarterly)
31
One a health policy is reinstated there is a:
10-day probationary period for sickness coverage. No probationary period for accident coverage
Written notice of claim must be given to the health insurer within ____ days after occurrence or commencement of any loss covered by the policy
20
Continuance of disability claims must notify insurer and may be required to provide proof once every
6 month
Insurers must provide a claim form within ___ days upon the receipt of the insured’s notice of health insurance claim
15
Written proof of loss must be provided to the health insurer within ___ days of the date of loss
90
Insurers must pay lump sum claims ______ after receiving proof of loss
Immediately
No legal action can be brought against health insurer:
-prior to 60 days after filing written proof of loss
-after the expiration of 3 years after proof of loss
Uniform (Mandatory) health insurance policy provisions
-entire contract
-Incontestability clause
-grace period
-reinstatement
-notice of claim
-claim forms
-proof of loss
-Time of payment of claims
-payment of claims
-physical exam and autopsy
-legal actions
-change of beneficiary
If the insured changes to a more hazardous occupation, the insurer will _______ benefits to whatever the premium would have purchased at the higher risk occupation
Reduce
If an insured has more than one policy of a similar type with an insurance company, the insurer can _______ the amount of benefits that will be paid under all contracts
Limit
If an insured has coverage with another insurer providing benefits for the same loss, the amount paid by the two insurers will be ________
Prorated
Unpaid premium can be deducted from
The benefit payable under the claim
The insurer may cancel a health policy at any time by giving the insured ___ days written notice
5
If the insurer cancels a health policy, unearned premium will be returned to the insured on a ___ ____ basis
Pro rata
Optional health insurance policy provisions
-change of occupation
-misstatement of age
-other insurance with this insurer
-insurance with other insurers
-relation of earnings to insurance
-unpaid premium
-cancellation
-conformity with state statutes
-illegal occupation
-narcotics
The most common health insurance free-look period is ____ days
10
Long-term care insurance and Medicare supplements have ___-day free-look periods
30
The ____ clause states the insurer’s promise to pay under the conditions described in the policy and identifies the type of loss covered by the contract
Insuring
_________ is an exchange of value and is a necessary element of a legal contract
Consideration
The more favorable the renewability provision is to the insured, the _______ the premium
Higher
