Policy Provisions, Clauses And Riders

Question 1

This was adopted by the National Association of Insurance Commissioners, adopted by all states, established standard provisions that are to be included in all individual health insurance policies

Answer 1

Uniform Individual Accident and Sickness Policy Provisions Law

Question 2

The following are mandatory provisions except:

Reinstatement
Grace Period
Entire Contract
Change of Occupation

Answer 2

Change of occupation

Question 3

What all is involved in the entire contract

Answer 3

The health policy, copy of the signed application, and any attached riders amendments

Question 4

Who has the authority to make changes to the policy

Answer 4

An executive officer of the company

Question 5

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

Answer 5

The grace period

Question 6

The grace period varies based on

Answer 6

The mode of premium: 7 days for weekly premium, 10 days for monthly premium, 31 days for all other modes

Question 7

This spells out the insureds duty to provide the insurer with reasonable notice in the event of a loss, required within 20 days of the loss or as soon as reasonably possible

Answer 7

Notice of claims

Question 8

Usually within 15 days of the receipt of a notice of claim the company must supply

Answer 8

Claims forms to the insured

Question 9

After a loss occurs, a claimant must provide what within 90 days of the loss or as soon as reasonably possible

Answer 9

Proof of loss

Question 10

This provision specifies claims are to be paid immediately upon written proof of loss

Answer 10

Time of payment of claims

Question 11

The following are all what?

1. Entire Contract
2. Grace Period
3. Reinstatement
4. Change of Beneficiary
5. Notice of Claim
6. Claim Forms
7. Proof of Loss
8. Time of Payment of Claims
9. Payment of Claims
10. Physical Examination and Autopsy
11. Time Limit on Certain Defenses (Incontestable)
12. Legal Actions
13. Misstatement of Age

Answer 11

These are Mandatory Provisions

Question 12

Located on the first page of the policy. It identifies the insured and the insurance company and states what kind of loss (peril) is covered

Answer 12

Insuring Clause

Question 13

Commonly the 10 day period from the date the policy is delivered.

Answer 13

Free look period

Question 14

Type of deductible that is commonly found in disability income policies. Period of days must expire from the onset of an illness or occurrence of an accident before benefits are payable

Answer 14

Elimination period

Question 15

A period of time that much lapse before coverage for specified conditions goes into effect

Answer 15

The probationary period

Question 16

A provision that provides for the sharing of expenses between the insured and the insurance company

Answer 16

Coinsurance