Mandatory Policy Provisions

Question 1

consists of the signed application, policy riders and provisions. The provision states that nothing outside the contract can be considered part of the contract. An insurer may change the wording of a health insurance contract only if the modification is not less favorable to the insured.

Answer 1

Entire contract

Question 2

The policy cannot be revoked by the insurer after a certain time frame (usually 2 years).

Answer 2

Time Limit on Certain Defenses -

Question 3

this period is 7 days for premiums payable on a weekly basis, 10 days for premiums payable on a monthly basis (HMO or PPO) and 31 days for all other policies. Under the Affordable Care Act, the blank is to make premium payments is 90 days.

Answer 3

grace period

Question 4

is automatic if the premium is received anytime during the grace period. If the insurer takes no action on the application for 45 days, the policy is reinstated automatically.

Answer 4

Reinstatement

Question 5

The policyowner must notify the insurer within a reasonable time frame of any claims (usually 20 days after the date of loss).

Answer 5

Notice of Claim

Question 6

The insurer must provide a blank to the insured within 15 days of receiving the notice of loss. If the insurer fails to supply the blank to the insured after 15 days of the notice, the insured may submit the loss in any form to the insurer.

Answer 6

Claim Forms

Question 7

The insured has 90 days to submit the blank following a claim.

Answer 7

Proof of loss

Question 8

The insurer must provide payment of the claim immediately after receiving
notification of the claim and the proof of loss.

Answer 8

Time payment of claims

Question 9

Health insurance contracts state who and how the payment will be made. Life insurance payments are payable to the beneficiary.

Answer 9

Payment of claims

Question 10

The insured may not file for legal action against the insurer in a claims dispute until after 60 days from the proof of loss.

Answer 10

Legal actions

Question 11

A policyowner may change the beneficiary at anytime unless it is an irrevocable beneficiary.

Answer 11

Change of beneficiary

Question 12

The insurer at its own expense may have a physical exam conducted on the insured. If a death, the insurer may request an autopsy report.

Answer 12

Physical exam and autopsy