Unit 14 Health

Generally, written proof of loss must be furnished within how many days after the loss?

90

A reinstated policy will cover

Accidents immediately and sickness after 10 days

Entire Contract

Application Insurance Policy Riders

Pre Existing Exclusions

Are still allowed for: Disability Policies Long-Term Care Insurance Medical Supplements Limited-Benefit Policies

The exchange of something of value is known as

Consideration

When Betty purchased her insurance policy, her age was recorded as 32 when she was actually 34. Assuming her policy includes the misstatement of age provision and the insurance company discovers this four years later, Betty's policy

Limits will be lowered

All of the following are mandatory health insurance provision, EXCEPT

Renewability

Time Limit on Certain Defenses

This provision states that after two years from the date of policy issue, no misstatements shall be used to void the policy or deny claims for loss after this period

Marcus pays his insurance premium monthly and has a grace period of

10 days

Free Look

10 days from receipt 30 days for senior products

Reinstatement requires

10-day probationary period for sickness coverage There is no probationary period for accident coverage

(Claim Forms). The insurer has

15 days to provide you with the form for your claim

(Notice of Claim). The insured has

20 days to inform insurance company about claim

How many days' notice must the insured be given if an insurer cancels a policy?

5

Mike allows his policy to lapse, then applies for reinstatement using the company's required application. The company does not inform Mike either that the policy has been accepted or that the policy is being rejected. At what point can Mike consider the policy reinstated?

After 45 days

Remewability

Can be classified into five types: -Cancelable: the insurer can cancel at anytime -Optionally Renewable: the insurer has the option to renew or not for any reason on a premium due or anniversary date. -Conditionally Renewable: the insurer may terminate coverage but only for reasons not based on the insured's health such as reaching a certain age. -Guaranteed Renewable: the policy cannot be canceled except for non-payment of premium -Non Cancelable: the insurer cannot cancel coverage or raise premiums

All of the following are optional health insurance provisions EXCEPT

Change of Beneficiary

Which provision allows new insureds the right to examine a policy for a specified period of time with the option to return it?

Free Look Period

Payment of Claims

How and to whom payments will be made

Physical Examination and Autopsy

Insurer pays all costs of either of these are necessary

Time Payment of Claims

Insurers must pay lump sum claims immediately after receiving proof of loss. For claims involving periodic payments such as disability income, payments must be made at least monthly

Legal Actions

No legal action can be initiated within 60 days after proof of loss has been submitted to the insurance company. In addition, no legal action can be initiated after 3 years from the initial time written proof of loss has been provided.

The optional provisions that deal with multiple insurance policies of the same type on a single insured deal with the problem of

Over-Insurance

The grace period varies according to

Premium payment frequency

If there is no beneficiary listed in a policy, benefits will be paid to

The insured's estate

Coverage is automatically reinstated 45 days after the application is submitted if

The insurer has not disapproved the application and notified the applicant by that time

Cancellation

The insurer may cancel a policy at any time by giving the insured five days written notice.

According to the entire contract provision, the entire contract includes all of the following EXCEPT

The premium payment What is included: Any endorsements The insurance policy Any attachments

A pro rata return is one in which the insurer returns

The proportionate amount of the unearned premium

Change of Beneficiary

The right to change is up to policy owner Revocable-anytime Irrevocable-permission needed

(Proof of Loss). Insured has to prove the insurance company of a loss

Within 90 days of loss

The insurer may generally require an autopsy at its own expense unless

the state has an applicable law that forbids autopsy

Grace Period

A specified time following the due date of a premium payment in which the premium has not been paid Grace's birthday 7/10/31 7 days- weekly premium policies 10 days- monthly premium policies 31 days-all other policies