Health Insurance Policy Provisions

Disability Income Policies

• A Noncancelable Disability Income Policy can only be terminated by the policyowner, with stable rates guaranteed.
• Claims for preexisting conditions are honored after the incontestable period, typically 2 to 3 years, regardless of undisclosed information at application.

Health Policy Provisions

• The Entire Contract provision prohibits producers from altering a policy or waiving provisions without authority.
• The Insuring Clause specifies covered benefits for accidents or illnesses.
• The Probationary Period starts at the policy's inception, during which no benefits are paid.
• The Waiver of Premium provision suspends premium payments if the insured is totally disabled for a specified period.

Claim Processing

• Insurers must provide claim forms within 15 days of receiving notice of a loss under the Claims Forms provision.
• The Time Limit on Certain Defenses limits the duration insurers can dispute claims based on misstatements made in applications.
• The Notice of Claims provision clarifies the insured's obligation to inform the insurer of a loss in a timely manner.

Coverage and Renewability

• Policies like Guaranteed Renewable policies can be renewed with premium adjustments based on risk classifications.
• Conditionally Renewable policies may adjust premium rates upon renewal.
• The Grace Period allows for late premium payments to keep coverage active.

Legal and Compliance Clauses

• The Consideration Clause details required conditions for policy validity, including completion of medical history questions.
• The Payment of Claims provision defines to whom benefits are payable.

Claims and Exclusions

• Medical claims must be reported within 20 days post-accident.
• Health insurance excludes benefits related to acts of war and intoxication.
• Periodic payment requirements for benefits, especially for disability income, must occur at least monthly.

Policy Adjustments

• The Change of Occupation provision allows insurers to modify benefits if the insured changes to a higher-risk job.

Important Definitions

• Proof of Loss is required to validate a claim.
• Coverage may be denied if conditions laid out in the policy, such as the time limits related to defense, are not met.

Test your knowledge on health insurance policy provisions with these flashcards. Each card covers key terms and definitions essential for mastering disability income policies. Perfect for students or professionals looking to refresh their understanding of insurance concepts.