Health Policy Provisions

Question 1

NAIC stands for?

Answer 1

National association of insurance commissioners

Question 2

How many mandatory provisions in health insurance contracts are there?

Answer 2

12 nigga

Question 3

1. Entire contract?

Answer 3

It protects the policy owner..
nothing outside of the contract can be considered part of the contract.
Also assures no changes will happen after it has been issued.
Any change to the policy must be made with the approval of the executive officer of the insurance company

Question 4

2. Time limit on certain defenses

Answer 4

The policy is incontestable after it has been in force a certain period of time (usually 2years)

Question 5

3. Grace period

Answer 5

Policy owner given a certain amount of days to pay premium before penalized.
7 days for weekly premium payments
10days for monthly
31 days for other policies

Question 6

4. Reinstatement

Answer 6

If insurer takes no action on the application for 45 days the policy is reinstated automatically… accidents are covered immediately upon reinstatement

Question 7

5. Notice of claim

Answer 7

Describes the policyowners obligation to the insurer to provide notification of loss within a reasonable period of time.. typically 20 days after incident

Question 8

6. Claim forms

Answer 8

It’s company’s responsibility to supply claim forms within 15days after receiving notice of claim… of company doesn’t then inured can submit claim in any for that must be accepted by company

Question 9

7. Proof of loss

Answer 9

Insured must give an insurance company proof that actual loss has occurred… insured has 90 days to submit proof of loss after claim has been filed

Question 10

8. Time of payment claims

Answer 10

Provides for immediate payment of the claim after insurer received notification and proof of loss. If claim involves disability income payments, they are paid out monthly

Question 11

9. Payment of claims

Answer 11

Specifies how and to whom claim payments are to be made

Question 12

10. Physical exam and autopsy

Answer 12

Entitles company to make physical examinations of the insured at reasonable intervals during period of claim

Question 13

11. Legal actions

Answer 13

Insured cannot take legal action against company in a claim dispute until after 60 days form the time the insured submits proof of loss.

Question 14

12. Change of beneficiary

Answer 14

The insured as policy-owner may change beneficiary at any time

Question 15

How many optional provisions are there?

Answer 15

11. And companies may ignore them or use only the ones they need in the policy forms

Question 16

1. Change of occupation

Answer 16

Allows insurer to reduce maximum benefit if the insured witches to more hazardous job or to reduce the premium rate charged if the insured switches to less hazardous

Question 17

2. Misstatement of age

Answer 17

Allows insurer to adjust the benefit payable if the age of then insured was misstated when policy was made

Question 18

3. Other insurance with this insurer

Answer 18

Designed to protect the insurer ol

Question 19

4. Insurance with other insurer

Answer 19

Not fair if accepted or something idk

Question 20

5. Insurance with other insurers

Answer 20

Allows insurer to pay benefits to the insured on a pro-rata basis when the insurer was not notified prior to the claim that the insured has other health coverage

Question 21

6. Relation of earnings to insurance

Answer 21

Insurer is liable only for that amount of benefits as the insureds earnings bears

Question 22

7. Unpaid premiums

Answer 22

Pay that shit niggy

Question 23

8. Cancellation

Answer 23

Gives the company the right to cancel policy at any time with 45 days of written notice to the insurer… if it’s because of non premium payments then it’s 10days

Question 24

9. Conformity with state statutes

Answer 24

Have to abide by that states law of where you signed contract

Question 25

10. Illegal occupation

Answer 25

Insurer is not liable for losses attributed to the insurers being connected with a felony participation in any illegal occupations

Question 26

11. Intoxicants and narcotics

Answer 26

Insurer is not liable for any loss attributed to the insured while intoxicated or under the influence of narcotics

Question 27

Insuring clause

Answer 27

States the kind of benefits provided and the circumstances under which they will be paid

Question 28

Consideration clause

Answer 28

Exchanging promises in the policy with two part consideration form insured… initial full premium required and statement made in the application

Question 29

Conversion privilege for dependents

Answer 29

Must provide dependent coverage up to age 26

Question 30

Waiver of premium

Answer 30

Waives payment of premiums after the insured has been totally disabled for the specified period of time

Question 31

Probationary period

Answer 31

Becomes effective at the inception of the policy

Question 32

Common exclusions or restrictions

Answer 32

War, self inflicted injuries and pilot or crew member of aircraft

Question 33

Impairment rider

Answer 33

When insurance company doesn’t cover insurers loss due to preexisting conditions

Question 34

The more favorable the renewability provision is to the insured policyholder the higher the premium

Answer 34

Yup

Question 35

Optionally renewable policy

Answer 35

Gives insurer the option to review policy and terminate the policy on a date specified in the contract

Question 36

Conditionally renewable policy

Answer 36

Allows insurer to terminate the coverage but only in the even of one or more conditions stated it he contract… also can increase premiums at time of renewal

Question 37

Guaranteed renewable policy

Answer 37

Policy muse be renewed until insured reaches specified age as long as premiums are paid… normally have increasing premiums

Question 38

Nonrenewable policies

Answer 38

Less than a year so fuck off