Unit 14 Health Insurance Policy Provisions Flashcards
entire contract
mandatory policy provision
includes application, insurance policy, riders. changes must be signed and attached to the policy
incontestability
mandatory policy provision
time limit on contesting application information. 2 years after application. fraud in the application can void the policy when discovered
grace period
mandatory policy provision
follows the due date of the premium
-if paid weekly, 7 days
-if paid monthly, 10 days
-if paid annually, semiannually, or quarterly, 31 days
insurance is still in force during this time
unpaid premiums are deducted from a claim
reinstatement
mandatory policy provision
application and receipt
must deny within 45 days after application or the policy is in effect
accident claims are covered immediately
sickness claims are covered 10 days after reinstatement
days 1-60 need to pay premium to gain coverage back
days 61+ need to apply, prove medical, and pay last 60 days premium
notice of claim
mandatory policy provision
written notice must be provided within 20 days after loss
if continuing disability can only be required to provide proof every six months
claim forms
mandatory policy provision
must be furnished to insured within 15 days of notice of loss
proof of loss
mandatory policy provision
written proof of loss within 90 days
time payment of claims
mandatory policy provision
immediately after receiving proof of loss
at least monthly if a periodic claim, such as a long-term disability policy or long-term care policy
payment of claims
mandatory policy provision
states how and to whom payments will be made
any death benefits (beneficiary or insured’s estate)
facility of payment ($1,000 to a family member)
medical exams and autopsy
mandatory policy provision
if the company requires and state law allows
insurer pays all costs if either of these are necessary
legal action against insurer
mandatory policy provision
earliest 60 days after proof of loss
maximum 3 years after proof of loss
change of beneficiary
mandatory policy provision
revocable - anytime by the owner
irrevocable - permission of the beneficiary needed
change of occupation
optional policy provision
more hazardous - reduction of benefits
less hazardous - refund of excess premiums
misstatement of age
optional policy provision
younger than stated in application - refund premium
older than stated in application - benefits reduced
insurance with other insurer
optional policy provision
each company pays a proportionate share
excess premiums are refunded
