LIFE Policy Riders, Provisions, Options and Exclusions 13% Flashcards
Who adopted the standard policy provisions and what do they create?
The National Association of Insurance Commissioners (NAIC)
it creates uniformity among life insurance policies
What provision stipulates that the policy and a copy of the application, along with any riders or amendments, constitute the entire contract
Entire Contract
Can statements made before writing of contract be use to alter the contract?
NO
When can a change in policy provisions happen?
When both parties agree to it (insurer/insured) and the change is affixed to contract
What provision sets forth the basic agreement between the insurer and the insured?
Insuring Clause (insuring agreement)
What is stated in the Insuring Clause provision?
states the insurers promise to pay the death benefit upon the insured’s death
Where is the policy is the insuring clause located?
The policies face page
What does the insuring clause define?
the premium to be paid, how long coverage is in force, and the amount of the death benefit
Which provision allows the policy owner a specified number of days from the receipt to look over the policy, and if dissatisfied for any reason, return it for a full refund of premium?
Free Look
When does the Free Look provision start?
When the policy owner RECEIVES the policy, NOT when insurer issues the policy
What is consideration?
something of value that each party gives to the other (binding force in any contract) for contract to be valid
Which provision states that the consideration (value) offered by the insured is the premium and statements made in the application, and the insurers consideration is the promise to pay within terms of contract?
The Consideration provision
Who are the parties to an insurance contract?
Insurer, policy owner, insured (if different than owner), and the beneficiary
Can policyowner be different than the insured?
Yes
Who has ownership rights under a policy?
Policy owner
not insured or beneficiary
What are the ownership rights under a policy?
1) Naming and changing the beneficiary if not irrevocable
2) receiving the policy’s living benefits
2) selecting a benefit payment option
3) Assigning the policy
Who has the responsibility of paying the policy premiums?
Policy owner
Who must have insurable interest in the insured at the time of application for insurance?
Policy owner
What is the insurance arrangement referred to as when the owner and the insured are not the same person?
Third-party ownership
What provision specifies the policy owner’s right to assign the policy (or transfer rights of ownership)
Assignment provision
Who has the right to transfer partial or complete ownership of the policy without consent of the insurer?
The policy owner
If assignment is being written, what must the policy owner do?
give notice to the insurer
What changes and doesn’t change in a transfer of a policy
Does not change the insured or amount of coverage
Does change who has ownership rights
What are the two types of policy assignments?
Absolute Assignment and Collateral Assignment
What is an Absolute Assignment?
transfer of all rights of ownership to another person or entity
What is a collateral assignment?
Transfer of partial rights to another person
Which assignment is permanent and which is temporary?
Absolute- permanent
Collateral- temporary
In an absolute assignment, does the new policy owner need to have insurable interest in the insured?
No
Which assignment is usually done in order to secure a loan or some other transactions?
Collateral
In a collateral assignment, when is the policy rights given back to the policy owner
When debt or loan is repaid
What does the policy stipulate?
when the premiums are due, how often they are due, and to whom
What are the different modes of payment?
Monthly, Quarterly, Semi-annually, and Annually
What is a Premium Mode?
manner or frequency that the policyowner pays the policy premium
What happens if a mode other than annually, is chosen?
There will be additional costs to offset the loss of earnings since the company doesn’t have the entire premium at once
What other costs are associated with a different mode of billing other than annual?
Administrative costs associated with more frequent billing
What happens when an insured dies during a period of time for which the premium has been paid?
The insurer must REFUND any unearned premium along with policy proceeds
What protects a policy owner for a period of time after the premium due date has to be paid before the policy lapses?
Grace Period
What is the purpose of the Grace Period?
to protect the policy holder against an unintentional lapse of the policy
What is usually the time the Grace Period is effective?
30 or 31 day, or one month after due date
What happens to the death benefit if the insured dies during the Grace Period?
Death benefit is still payable, but any unpaid premiums are deducted
What is a level premium policy?
the premium remains the same throughout the duration of the contract
What is a flexible premium policy?
allows the policy owner to increase or decrease the premium during the policy period
Which provision allows a lapsed policy to be put back in force?
Reinstatement
What is the maximum time limit for reinstatement of a policy?
Usually 3 years after policy has lapsed
What is required when a policy owner reinstates a policy?
1) provide proof of insurabillity
2) Pay all back premiums plus interest
3) may repay any outstanding loans and interest
What is the advantage of reinstating a lapsed policy as opposed to purchasing a new one?
Policy will be restored to its original status
and
It’ll retain all values that were established and the insureds issue age
Can a surrendered policy be reinstated?
No
What prevents an insurer from denying a claim due to a statements in the application after the policy has been in force for 2 years?
Incontestability Clause
Can an insurer deny a claim even if there has been material misstatement of facts or concealment of a material fact after 2 years in a policy?
No, not in the Incontestability clause
When does the Incontestability clause not apply?
doe not apply in the event of nonpayment of premiums, nor statements regarding age, sex, or identity
What can be changed at any time in an insurance policy if misstated?
Age and Gender
Which information is important for knowing what premiums to charge?
Age and Gender
What happens in the event of a claim but a person has misstated their age or gender?
Insurer allowed to adjust the benefits to an amount that the premium at the correct age or gender would have purchased
What is a beneficiary?
person or interest to which the policy proceeds will be paid upon death of the insured
What are the different types of beneficiaries?
1) person
2) class of person (i.e children)
3) insured’s estate
4) Institution or other entity such as a foundation, charity, corporation or trustee of trust
Does the beneficiary need to has insurable interest in the insured?
No
Does a beneficiary need to be named for a policy to be valid?
No
What are the 3 levels of priority or choice for beneficiary designation?
Primary, Contingent, Estate
When are the benefits available to each level of succession?
When the level before each succession dies before them (i.e. primary, then contingent, and so on)
Who has first claims to the death benefit?
Primary
Who has second claim to the death benefit if the primary dies before the insured?
Contingent (secondary or tertiary)
Who receives the death benefits if both the primary and contingent die before the insured?
Insured’s estate
What will happen in the event no beneficiary is named and the insured dies?
Automatically passes to the Insureds estate and death benefit of the policy may be included in the insureds taxable estate
What are the two beneficiary designations?
Revocable and Irrevocable
Which beneficiary designation can be changed without the consent of the beneficiary?
Revocable
Which beneficiary designation CANNOT be changed without consent of beneficiary?
Irrevocable
What can’t the insured change beneficiaries in an irrevocable beneficiary?
the beneficiary has vested interest in the policy
What can’t the insured do in the irrevocable situation towards the policy without consent of beneficiary?
Borrow against policies cash value (would decrease policy’s face value) or assign the policy to another person
Which law protects the contingent beneficiary and stipulates that if the insured and primary beneficiary die in the same accident without knowing who died first, the death benefit will be distributed as if the primary died first?
The Uniform Simultaneous Death Law
What happens in a Common Disaster Clause when added to a policy?
Provides that if the insured and primary died in a common disaster (even if primary outlived the insured by a specified number of days), then it is presumed that the primary died first, and benefits go to Contingent or insureds estate
What is the Time frame the primaries death must occur in order for the Common Disaster clause to apply and is interpreted as the primary died first?
14 to 30 days
When it the Policy Loan option available?
In policies that contain cash value (whole life)
What happens in the policy loan option?
The policyowner is entitled to borrow an amount equal to the available cash value
What happens in the event of a policy loan to the policy proceeds in event of insureds death?
Outstanding loans and accrued interest will be deducted from policy proceeds
With an outstanding policy loan, in what event will a policy lapse?
if the outstanding loan and accrued interest exceed available cash value
What time frame must an insurer provide written notice that policy will lapse in a policy loan situation?
30 days
How long can a company defer a policy loan?
up to 6 months except if reason for loan is to pay policy premiums
Are policy loans subject to income taxation?
Yes
What type of special loan prevents the unintentional lapse of a policy due to nonpayment of a premium?
Automatic Premium Loans
Is the automatic premium loan charged interest?
Yes
What happens if the loan and interest are not repaid by the time the insured dies?
The outstanding amounts will be subtracted from the death benefit
When are the loan requests for payments of due premiums honored?
Immediately
What are Exclusions?
types of risks that the policy will not cover
What are the most common exclusions found in life insurance policies?
Aviation, Hazardous Occupation, and War and Military Service
What happens with noncommercial pilots?
Excluded for coverage, or pay an additional premium for coverage
What type of aviation WILL a life insurance cover?
insured is a fare-paying passenger or a pilot on a regularly scheduled airline