Individual Accident and Health - A Standard Provisions

Question 1

The ________________, which was developed by the National Association of Insurance Commissioners (NAIC), has
been adopted in all states.

Answer 1

Uniform Individual Accident and Sickness Policy Provisions Law

Question 2

This law established standard provisions that are to be

included in all individual health insurance policies

Answer 2

Uniform Individual Accident and Sickness Policy Provisions Law

Question 3

The ________________ states that the health insurance policy, together with a copy of the signed application and attached riders and amendments, constitutes the entire contract.

Answer 3

entire contract provision

Question 4

No changes may be made to the policy without
the express _______________, and any changes must also be made a part of the contract . Only an executive officer of the company, not an agent, has authority to make any changes to the policy

Answer 4

written agreement of both parties

Question 5

______________ ensures that No statement or misstatement (except fraudulent misstatements) made in the application at the time of issue will be used to deny a claim after the policy has been in force for 2 years

Answer 5

The time limit on certain defenses provision

Question 6

The ________ is the period of time after the premium due date in which premiums may still be paid before the policy lapses for nonpayment of the premium

Answer 6

grace period

Question 7

the grace period can be not less than \_\_\_\_\_\_\_ for weekly
premium policies (industrial policies), \_\_\_\_\_\_\_\_\_ for monthly premium policies, and \_\_\_\_\_\_\_\_\_\_ for all other modes. Coverage will continue in force during the grace period

Answer 7

7 days
10 days
31 days

Question 8

The __________ provision spells out the insured’s duty to provide the insurer with reasonable notice in the event of a loss. Notice is required within 20 days of the loss, or as soon as reasonably possible. Notice to the agent equals notice to the insurer.

Answer 8

notice of claim

Question 9

Upon receipt of a notice of claim, the company must supply claims forms to the insured within a specified number of days usually

Answer 9

15

Question 10

After a loss occurs, the claimant must submit__________ within 90 days of the loss or as soon as reasonably possible, but not to exceed one year

Answer 10

proof of loss

Question 11

The time of payment of claims provision specifies that claims are to be paid immediately, but no longer than _________, upon written proof of loss.

Answer 11

30 days

Question 12

The _____________ provision specifies to whom claims payments are to be made. All benefits are payable to the insured while he or she is living.

Answer 12

payment of claims

Question 13

Some policies allow a provision that gives the insurer the right to expedite payments of urgently needed claim funds. This called

Answer 13

facility of payment clause

Question 14

The ______________ provision gives the insurer the right to examine the insured, at its own expense, as often as may be reasonably necessary while a claim is pending.

Answer 14

physical exam and autopsy

Question 15

The __________ provision stipulates that the policy owner may change the beneficiary at any time by providing a written request to the insurer, unless the beneficiary is designated as irrevocable The consent of the beneficiary is not required. If the beneficiary designation is irrevocable, the policyholder must first
obtain the permission of the beneficiary before any change can be made

Answer 15

change of beneficiary

Question 16

The _____________ provision specifies that the insured may cancel the policy at any time by written notice delivered or mailed to the insurer or the insurer’s representative

Answer 16

cancellation by the insured

Question 17

If the insured cancels the policy, the insurer must promptly return any unearned portion of the_____________.

Answer 17

premium