IV. Individual Health Insurance Policy General Provisions Flashcards
Ind. Health:
What is included in the entire contact?
Health insurance policy,
copy of signed application and
attached riders and amendments.
Ind. Health:
Who has the authority to change a policy provision?
The executive officer of the company, not an agent.
Ind. Health:
What are the grace periods for an individual policy?
7 days for weekly premium policies (industrial policies)
10 days for monthly
31 days for all other modes
Ind. Health:
Coverage is automatically reinstated if not refused within ___ days from the date of the conditional receipt was issued.
45
Ind. Health:
How long after reinstatement will accidents be covered?
Immediately
Ind. Health:
How long after reinstatement will sickness be covered?
Only after 10 days to prevent adverse selection
Ind. Health:
Which provision states to whom the claims are to be paid?
Payment of Claims
Ind. Health:
Who decides which optional provisions are included in a policy?
The insurance company
Ind. Health:
In what specific way could changing to a more dangerous occupation affect a person’s insurance policy?
Reduction in benefits to match what the premiums paid would have purchased assuming the more hazardous occupation.
Ind. Health:
If the insured misstates his/her age, how will benefits be paid?
Policy would be adjusted to what the premium paid would have purchased if done correctly.
Ind. Health:
What does the ‘other insurance with this insurer’ provision try to protect against?
Multiple policies with the same company:
provides for a pro rata benefit reduction and return of premium in the event of multiple policies with the same company when the benefits exceed a stated maximum.
Ind. Health:
What does the Insurance With Other Insurers provision protect against?
If the insured as 2 or more policies from different companies that provide benefits on an expense-incurred basis, and the policies cover the same expenses, and if hte insurance companies were not notified of the other coverage existed, then each insurer will pay a proportionate share of any claim.
Ind. Health:
What is identified in the insuring clause?
Identifies the insured and the insruance company and states what kind of loss (peril) is covered.
Ind. Health:
Where is the consideration clause usually located in the policy?
What is consideration for both parties?
First page
Applicant: Payment of premium and the sattements in the application.
Insurer: Promise to pay in accordance with the contract terms.
Ind. Health:
What is the difference between a guaranteed renewable and noncancellable policy?
They are similar, except that the insurer can increase the policy premium on the policy anniversary date in guaranteed renewable.
Ind. Health:
Which renewal provision gives the insured the right to renew the policy for the life of the contract but allows the insurer to alter premiums?
Guaranteed Renewable
Ind. Health:
What is the difference between a conditionally renewable policy and one whose renewability is optional?
Optional renewability allows the insurer to cancel the policy for any reason whatsoever.
Ind. Health:
When is notice required for a claim?
Within 20 days of the loss, or as soon as reasonably possible. Notice to the agent equals notice to the insurer.
Ind. Health:
When must the company supply claims forms to the insured after receipt of the notice of claim?
Within a specified number of days, usually 15. If forms are not furnished, the claimant is deem?ed to have complied with the requirements of the policy if he or she submits written proof of the occurrence, nature of the loss, and extent of loss to the insurer.
Ind. Health:
How long after a loss occurs must the claimant submit proof of loss
Within 90 days or as soon as reasonably possible, but not to exceed one year. (unless not legally competent to comply)
Ind. Health:
Time of payment of claims specifies?
and regarding disability income benefits?
Claims are to be paid immediately upon written proof of loss. Usually specified as 60, 45, or 30 days. If claim involves disability income benefits, the benefits must be paid not less frequently than monthly.
Elimination Period?
type of deductible commonly found in disability income policies. Period of days which must expire after the onset of an illness or occurrence of an accident before benefits will be payable.
