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health insurance part 6 - health provisions

Terms in this set (16)

An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the

medical examination is given

producer completes the application

insurer dates the policy

the first premium is paid
insurer dates the policy
The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is:
Time Limit on Certain Defenses
When does a Probationary Period provision become effective in a health insurance contract?

At the policy's inception

30 days after the policy's inception

When a claim is submitted

When a covered loss occurs
At the policy's inception
What type of rider would be added to an Accident and Health policy if the policy owner wants to ensure the policy will continue if he/she ever becomes totally disabled?
Waiver of Premium rider("Waiver of Premium rider".

If a policyowner covered under an accident and health policy wanted to ensure the policy will continue if they ever become totally disabled, they would want to add a waiver of premium rider.
The clause in an accident and health policy which defines the benefit amounts the insurer will pay is called the:
insuring clause
What must the policyowner provide to the insurer for validation that a loss has occurred?
proof of loss
With Optionally Renewable Health policies, the insurer may
review the policy annually and determine whether or not to renew it
A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim?
Claim will be paid and coverage will remain in force.

Because After a policy has been in force for 2 (sometimes 3) years, it enters the incontestable period, in which the insurer may not deny a claim based on information not disclosed at the time of application.
When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the?
Entire Contract provision

(The Entire Contract provision states that the application and policy contain all provisions and constitute the entire contract.)
Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate?
Guaranteed Renewable("Guaranteed Renewable".

The renewal provision in a guaranteed renewable policy specifies that the policy must be renewed (as long as premiums are paid) until the insured reaches a specified age. These usually have increasing premiums.
J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase?
Noncancelable .

( A Disability Income Policy that only the policyowner can terminate and on which the rates will never increase is a Noncancelable policy.
which of these is considered a mandatory provision?

Payment of claims

insurance with other insurers

misstatements of age

change of occupation
"Payment of Claims". Payment of Claims is considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions.
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?
the insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?
File written proof of loss
The notice of claims provision requires a policyowner to:
notify an insurer of a claim within a specified time
an __________ of benefits of a health policy transfers payments to someone other than the policy owner
assignment
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