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
