Podcast
Questions and Answers
Which of the following types of policies did J purchase?
Which of the following types of policies did J purchase?
Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions?
Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions?
Which health policy clause specifies the amount of benefits to be paid?
Which health policy clause specifies the amount of benefits to be paid?
When does a probationary period provision become effective in a health insurance contract?
When does a probationary period provision become effective in a health insurance contract?
Signup and view all the answers
How will the insurer handle a claim for a chronic neck problem that originated before the application was taken?
How will the insurer handle a claim for a chronic neck problem that originated before the application was taken?
Signup and view all the answers
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
Signup and view all the answers
What describes the Waiver of Premium provision in an Accident and Health policy?
What describes the Waiver of Premium provision in an Accident and Health policy?
Signup and view all the answers
Under the Change of Occupation provision, what action may the insurance company take?
Under the Change of Occupation provision, what action may the insurance company take?
Signup and view all the answers
What is the insuring clause?
What is the insuring clause?
Signup and view all the answers
What is the characteristic of a waiver of premium provision?
What is the characteristic of a waiver of premium provision?
Signup and view all the answers
What is the Time Limit on Certain Defenses provision?
What is the Time Limit on Certain Defenses provision?
Signup and view all the answers
Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65?
Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65?
Signup and view all the answers
What is the grace period in health insurance policies?
What is the grace period in health insurance policies?
Signup and view all the answers
Which clause specifies the conditions that must be met for a policy to be valid?
Which clause specifies the conditions that must be met for a policy to be valid?
Signup and view all the answers
What is the notice of claims provision?
What is the notice of claims provision?
Signup and view all the answers
What does the Payment of Claims provision state?
What does the Payment of Claims provision state?
Signup and view all the answers
What is the purpose of the Grace Period?
What is the purpose of the Grace Period?
Signup and view all the answers
What happens if the insurer does not send claims forms within the required time period?
What happens if the insurer does not send claims forms within the required time period?
Signup and view all the answers
What is a characteristic of a Conditionally Renewable Health Insurance policy?
What is a characteristic of a Conditionally Renewable Health Insurance policy?
Signup and view all the answers
What does the Time of Payment of Claims provision ensure?
What does the Time of Payment of Claims provision ensure?
Signup and view all the answers
What is the minimum frequency for periodic health claim payments?
What is the minimum frequency for periodic health claim payments?
Signup and view all the answers
Which of the following statements describes what an Accident and Health policyowner may NOT do?
Which of the following statements describes what an Accident and Health policyowner may NOT do?
Signup and view all the answers
Study Notes
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
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.
