Health Insurance: Policy Provisions

Question 1

Name the 12 Health Insurance Policy Provisions

Health Insurance: Policy Provisions

Answer 1

1. Entire Contract
2. Time Limit (Contesting Application Information)
3. Grace Period
4. Reinstatement
5. Notice of Claim
6. Claim Forms
7. Proof of Loss
8. Time Payment of Claims
9. Payment of Claims
10. Medical Exams and Autopsy
11. Legal Action
12. Change of Beneficiary

Question 2

Policy Provisions:
Entire Contract

3 Parts

Health Insurance: Policy Provisions

Answer 2

Remember AIR

The policy represents a contract between the Insurer and the Insured and consists of:
1. Application (Copy of Application)
2. Insurance Policy (Contract itself)
3. Riders (Any additional Endorsements/Amendments)

Question 3

Policy Provisions:
Time Limit
(Incontestability Clause)

2 Parts

Health Insurance: Policy Provisions

Answer 3

• After 2 years, any misstatements (by applicant) on the application cannot be used to void the policy or deny a claim for loss
  (from the date of policy issue)
• Fraudulent Statements can be contested at any time

Question 4

Policy Provisions:
Grace Period

3 Parts / 3 Sub-Parts

Health Insurance: Policy Provisions

Answer 4

• Specified timeframe where coverage is still in force, if Premium Payment has not been paid
• Unpaid premiums are deducted from any claims submitted during Grace Period window

Grace Periods:
* Weekly - 7 Days
* Monthly - 10 Days
* All Others - 31 Days
(Quarterly, Semi-Annually, and Annually)

Question 5

Policy Provisions:
Reinstatement

Health Insurance: Policy Provisions

Question 6

Policy Provisions:
Notice of Claim

Health Insurance: Policy Provisions

Question 7

Policy Provisions:
Claim Forms

Health Insurance: Policy Provisions

Question 8

Policy Provisions:
Proof of Loss

Health Insurance: Policy Provisions

Question 9

Policy Provisions:
Time Payment of Claims

Health Insurance: Policy Provisions

Question 10

Policy Provisions:
Payment of Claims

Health Insurance: Policy Provisions

Question 11

Policy Provisions:
Medical Exams/Autopsy

Health Insurance: Policy Provisions

Question 12

Policy Provisions:
Legal Action

Health Insurance: Policy Provisions

Question 13

Policy Provisions:
Change of Beneficiary

Health Insurance: Policy Provisions