HI Provisions

Question 1

Uniform Individual Accident & Sickness Policy Provisions Law

Answer 1

standardized contract language in individual accident and health policies

Question 2

Reinstatement

Answer 2

Application and receipt. Must deny within 45 days after application/policy is in effect (Accident claims covered immediately. Sickness claims covered 10 days after reinstatement)

Question 3

Notice of Claim

Answer 3

20 days after loss (If continuing disability can only be required to provide proof every six months)

Question 4

Claim Forms

Answer 4

must be furnished to insured within 15 days of notice of loss

Question 5

Proof of Loss

Answer 5

Within 90 days

Question 6

Time of Payment Claims

Answer 6

At least monthly if a periodic claim such as a long term disability policy or long term care policy. (Insurer pays immediately)

Question 7

Payment of Claims

Answer 7

Any death benefits (Beneficiary, Insured’s Estate). Facility of Payment ($1k to a family member)

Question 8

Physical Exam & Autopsy

Answer 8

If company requires and state law allows (Insurer pays all costs)

Question 9

Legal Actions

Answer 9

Earliest - 60 days after proof of loss. Max - three years after proof of loss

Question 10

Change of Beneficiary

Answer 10

can be done at any time by policy owner if recovable. Permission of beneficiary needed if irrevocable

Question 11

Change of Occupation

Answer 11

More hazardous = reduction of benefits. Less hazardous = refund of excess premiums

Question 12

Misstatement of Age

Answer 12

Younger than stated in application = benefits increased. Older than stated in application = benefits reduced

Question 13

Other Insurance with This Insurer

Answer 13

Total of all policies exceeds maximum (benefits reduced, excess premiums refunded)

Question 14

Insurance with Other Insurers

Answer 14

Each company pays a proportionate share. Excess premiums are refunded

Question 15

Relation of Earnings to Insurance (Average Earnings)

Answer 15

Disability benefits exceeds earnings. (Benefit reduced, excess premiums refunded)

Question 16

Unpaid Premium

Answer 16

can be deducted from the claim

Question 17

Cancellation

Answer 17

Company must give at least a five day notice. Unearned premium must be refunded pro rata. Insured cancels short rate penalty will apply

Question 18

Conformity with State Statutes

Answer 18

makes policy comply with laws of the insured’s state of residence

Question 19

Illegal Occupation

Answer 19

No benefits (if committing a felony or engaged in an illegal occupation

Question 20

Narcotics

Answer 20

No benefits (loss caused by alcohol or narcotics unless doctor’s orders)

Question 21

Right to Examine (Free Look)

Answer 21

10 days from receipt (30 days for senior products/medicare/LTC). Begins on the date received by policyholder. If policy returned - complete refund of money.

Question 22

Insuring Clause (First provision)

Answer 22

states the insurer’s promise to pay and conditions of payment

Question 23

Consideration Clause

Answer 23

company promises to pay. applicant provides information and pays premium

Question 24

Renewability

Answer 24

whether an insurer may refuse to renew a policy depends upon this provision in the policy

Question 25

Cancelable

Answer 25

the insurer can cancel the policy at any time

Question 26

Optionally Renewable

Answer 26

the insurer has the option to renew or not for any reason on a premium due or anniversary date (premiums may be increased on policy anni.)

Question 27

Conditionally Renewable

Answer 27

the insurer may terminate coverage but only for reasons not based on the insured’s health such as reaching a certain age. (premiums may be increased on policy anni.)

Question 28

Guaranteed Renewable

Answer 28

the policy cannot be canceled except for non-payment of premium, and premiums may increase on a renewal date if the insurer has raised premiums for all insureds in that coverage class

Question 29

Military Suspense Provision

Answer 29

temporary suspension while in military (reactivated after leaving military)