Health Insurance Policy Provisions, Clauses, & Riders

Grace Period

(for nonpayment of premium) the time between the billing date and the payment due date when no interest is charged; premium may still be paid before the policy lapses

NAIC

- National Association of Insurance Commissioners - No legal power of its own; composed of all 50 states, DC, and the 4 US territories - Encourages uniformity in state insurance laws and regulations

Entire Contract

A provision that states that the health insurance policy, together with a copy of the signed application and attached riders and amendments, constitutes the entire contract; no changes made to the policy without the express written consent of both parties.

Guaranteed Renewable

A rider in some insurance policies that guarantees that a policy is renewable, without the need for further underwriting and usually at the same premium or a premium no greater than charged for a similar class of policyholders.

Relation of Earnings to Insurance provision

Allows the insurance company to limit the insured's benefits to his/her average income over the last 24 months.

What provision in a life insurance policy would allow the insurer, after the death of the insured, to pay benefits to a person not named in the policy as beneficiary?

Facility of Payment Clause

Provision

In health insurance, provision describes procedures or rights that the insurer or the policyholder will take as described on a contractual basis in agreement with the other.

Facility of Payment Clause

Insurer rights to expedite payments of urgently needed claim funds, and to pay up to limit for relative or facility

Uniform Individual Accident and Sickness Policy Provisions Law

Law that established standard provisions to be included in all individual health insurance policies, some similar to life insurance policies; Developed by the NAIC

pro rata basis

Method for refunding a premium when an Insurer cancels a policy, based on the number of days the policy is in effect.

NAIC

National Association of Insurance Commissioners, an organization composed of insurance commissioners from all 50 states, the District of Columbia and the 4 U.S territories, formed to resolve insurance regulatory issues.

Amendment

a change or addition after a policy is issued

Irrevocable Beneficiary

beneficiary cannot be changed ; no changes without consent of beneficiary - used by banks or in divorces - if beneficiary wants the contract, he can get it

Total Disability

inability of the insured to perform any occupation for which he or she is reasonably suited by reason of education, training or experience

Waiver

relinquishment of a right or interest

Reinstatement

restoration of a lapsed policy; includes provision that reinstates automatically

Lapse

terminate