Insurance Policy Provisions Quiz

Components of your policy that outline specific benefits, terms, conditions, or other important features.

A provision stating that the policy, application, riders, and amendments form the entire contract. Statements made before the contract are not binding.

The time period after a premium is due during which the policyholder can make a payment without losing coverage (usually less than 30 days).

Limits the time during which the insurer can deny a claim or void the policy due to a misstatement by the insured.

Conditions under which a lapsed policy can be reinstated. Requires payment of overdue premiums and proof of insurability.

Specifies the time frame within which the insured must notify the insurer of a claim, typically within 20 days of the occurrence.

Obligation of the insurer to provide claim forms to the insured within a specified time frame, usually 15 days.

A statement of facts about a loss for which the insured is making a claim, generally within 90 days.

Provides for immediate payment of the claim after the insurer receives notification and proof of loss. Typically within 45 days.

A provision that specifies to whom claim payments are to be made.

A provision that allows an insurer, at its own expense, to have an insured physically examined or an autopsy performed when a claim is pending (unless prohibited by law).

The insured cannot take legal action against the company in a claim dispute until after 60 days from the time the insured submits proof of loss.

The insured, as policyowner, may change the beneficiary designation at any time unless a beneficiary has been named irrevocably.

Adjusts benefits or premiums if the insured's age or gender was misstated on the application.

Allows the insurer to adjust benefits or premiums if the insured changes to a more hazardous occupation.

The insurer is not liable for coverage on injuries that are sustained during illegal activities.

Allows the insurer to change policy benefit if insured's income has decreased, portion of the premium will be refunded.

States the scope and limits of the coverage provided by the insurance policy.

Permits policy owners 30 days to examine their new policy at no obligation. (Like a Free Trial).

States the amount and frequency of premium payments required for the insurance policy.

The period of time between the effective date of a health insurance policy and the date coverage for all or certain conditions begins. No benefits are payable during this period.

Amount of time that lapses after a disabling event before the insurance company begins to pay benefits. Usually around 30 days.

Waives premium payments during a period of total disability, allowing the policy to remain in force without cost to the insured.

Specifies conditions or circumstances not covered by the insurance policy.

Medical conditions that existed before the policy's start date, which may be excluded or subject to a waiting period.

The percentage of costs shared by the insured and insurer, typically after the deductible is met.

Amount the insured pays first before benefits are paid by the plan.

Medical expenses covered by the insurance policy.

A fixed amount the insured pays for covered services, often at the time of service.

Certain procedures or services require prior approval from the insurer to be covered.

Charges deemed reasonable for services in a geographical area, used to determine the amount covered by the insurer.

Caps on the benefits payable by the insurer over the policyholder's lifetime, annually, or per incident.

A provision that adds something to a policy. It can expand coverage or waive certain conditions.

Specified hazards listed in a policy for which benefits will not be paid.

Allows a policyholder to purchase specified amounts of additional insurance with out the evidence of insurability. AKA GIB.

Provides the option to increase coverage amounts at future dates without additional medical exams.

Type of Health Insurance policy that the company may not cancel, but must renew to a certain age with no change in premium. Affords the greatest degree of continuation protection to the insured.

Policy that can be terminated by the insurer.

The policy must be renewed (as long as premiums are paid) until the insured reaches a specified age, such as 60 or 65.