Policy Provisions, Clauses, and Riders Flashcards
What is the name of the act by the insured to voluntarily give up insurance?
Cancellation
Under an individual disability income policy, the benefits must be paid on at least what schedule?
Monthly
What health policy provision defines the insured’s duty to provide the insurer with reasonable notice in the event of a loss?
Notice of claim
If the insured pays a monthly premium for health insurance, how long would the grace period be on the policy?
10 days
What is the main difference between coinsurance and copay?
Copay is a set dollar amount; coinsurance is a percentage of the expenses
What section of a health insurance policy lists the services for which the insurer will not provide coverage?
Exclusions
Who decides which optional provisions would be included in a health policy?
The insurance company
The insured on a health policy misstated his age on the insurance application. If this misrepresentation is discovered, what will happen to the policy?
The benefit amount payable under the policy will be adjusted to the insured’s correct age
What health policy provision states to whom the claim benefits must be paid?
Payments of claim
After the elimination period, a totally disabled insured qualified for benefits from a disability policy that has a waiver of premium rider. What will happen to the premium that was paid into the policy during the elimination period?
Premium will be refunded
What will determine the length of the grace period in a health insurance policy?
The mode of the premium payment
If a health insurance policy has a 31-day grace period, what does that mean?
The policy remains in effect for 31 days after the premium is due and not paid
What health policy provision describes the insured’s right to cancel coverage?
Renewability provision
When can an irrevocable beneficiary be changed?
With the written consent of the beneficiary
What is the purpose of the coinsurance provision in health insurance policies?
To prevent overutilization of the policy benefits
What health policy provision allows the insured a period of time to examine the policy and determine whether to keep it?
Free-look period
What is a deductible in a health insurance policy?
A specified dollar amount that the insured must pay before the insurer will pay the policy benefits
Who pays the expense for an autopsy under the physical examination and autopsy provision?
The insurer
According to the reinstatement provision, once a lapsed policy is reinstated, how soon will coverage be available for accidents?
Immediately
What is a probationary period in group health insurance?
The period of time that must lapse before an employee is eligible for group health coverage
A waiver of premium provision may be included with what type of health insurance policies?
Disability income
What does the free-look period allow the insured to do?
Return the policy for a full refund of premium within a specified time period (10 days)
According to the time limit on certain defenses provision in health insurance policies, when can an insurer contest fraudulent misstatements on a health insurance application?
Any time while the policy is in force
What are the usual/reasonable and customary charges based on?
Average charge for a given procedure in the specific geographic area
Which health insurance provision describes the insured’s right to cancel coverage?
Renewal provision
What health policy provision prevents the insured from bringing a lawsuit against the insurance company for at least 60 days after proof of loss is provided?
Legal actions
What provision provides for the sharing of expenses between the insured and the insurance company?
Coinsurance
How will changing one’s occupation to be more hazardous affect the health insurance policy in force?
Claim benefits will be reduced to what the premium would have bought for a more hazardous occupation
What will happen to a health insurance policy if the premium has not been paid by the end of the grace period?
The policy will be canceled
