Podcast
Questions and Answers
What is the purpose of the Free Look provision in an insurance policy?
What is the purpose of the Free Look provision in an insurance policy?
What defines the period before certain benefits are payable in health insurance?
What defines the period before certain benefits are payable in health insurance?
Which clause may limit coverage for medical conditions existing before the policy takes effect?
Which clause may limit coverage for medical conditions existing before the policy takes effect?
What does the Coinsurance feature indicate in an insurance policy?
What does the Coinsurance feature indicate in an insurance policy?
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What is typically indicated by a Waiver of Premium in an insurance policy?
What is typically indicated by a Waiver of Premium in an insurance policy?
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Which of the following riders allows additional insurance to be purchased without proof of insurability?
Which of the following riders allows additional insurance to be purchased without proof of insurability?
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What does a Cancelable insurance policy enable the insurer to do?
What does a Cancelable insurance policy enable the insurer to do?
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What does the term 'Usual, Reasonable, and Customary (URC) Charges' refer to in health insurance?
What does the term 'Usual, Reasonable, and Customary (URC) Charges' refer to in health insurance?
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What does the Incontestable Clause generally state regarding the insurer's ability to contest a policy's validity?
What does the Incontestable Clause generally state regarding the insurer's ability to contest a policy's validity?
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What is generally required from the insured to process a claim according to the Proof of Loss provision?
What is generally required from the insured to process a claim according to the Proof of Loss provision?
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What does the Grace Period allow the policyholder to do?
What does the Grace Period allow the policyholder to do?
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What is the purpose of the Change of Beneficiary clause in an insurance policy?
What is the purpose of the Change of Beneficiary clause in an insurance policy?
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Which statement about the Relation of Earnings to Insurance provision is correct?
Which statement about the Relation of Earnings to Insurance provision is correct?
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What condition does the Illegal Occupation clause impose?
What condition does the Illegal Occupation clause impose?
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What does the Time of Payment of Claims provision specify?
What does the Time of Payment of Claims provision specify?
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What is outlined by the Insuring Clause in an insurance policy?
What is outlined by the Insuring Clause in an insurance policy?
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Study Notes
Insurance Policy Provisions
- Mandatory Provisions: Essential terms defining the insurer and insured's rights and duties.
- Entire Contract: The policy and endorsements are the complete agreement.
- Incontestable Clause: After a set time (usually two years), insurers cannot dispute the policy's validity due to misstatements, except for fraud.
- Grace Period: A time after the premium due date where paying the premium doesn't lose coverage.
- Reinstatement: Allows a lapsed policy's restoration by paying past premiums and meeting other conditions.
- Claim Notice: Timeframe and process to notify the insurer of a claim.
- Claim Forms: Insurers provide forms for filing claims.
- Proof of Loss: Insured provides documentation proving the loss.
- Time of Claim Payment: Time for claim payment after proof of loss.
- Payment of Claims: Details who receives the claim payment.
- Physical Exams/Autopsy: Allows the insurer to examine/conduct an autopsy for claim evaluation.
- Legal Actions: Time limit for legal action to enforce the policy.
- Beneficiary Change: Policyholder's procedure for changing beneficiaries.
- Misstated Age/Gender: Insurer can adjust benefits based on the correct age/gender.
- Change of Occupation: Insurer may adjust premiums/coverage if occupation changes.
- Illegal Occupation Exclusion: Coverage exclusion for injuries from illegal activities.
- Relation of Earnings to Insurance: Benefits are often proportional to the insured's earnings (e.g., disability insurance).
Other Provisions and Clauses
- Insuring Clause: The insurer's promise to provide coverage – the core agreement.
- Free Look Period: A specified time (typically 10-30 days) to review and cancel the policy without penalty.
- Consideration Clause: Details the exchange of value (premiums for coverage).
- Probationary Period: Waiting time before some benefits are payable.
- Elimination Period: Similar to a deductible, waiting time before disability benefits.
- Waiver of Premium: Allows premium pauses during disability or qualifying events.
- Exclusions and Limitations: Details what the policy does not cover.
- Pre-existing Conditions: Clause potentially limiting or excluding coverage for conditions before policy start.
- Coinsurance: Policyholder shares a percentage of costs after the deductible.
- Deductibles: Amount insured pays before coverage begins.
- Eligible Expenses: Covered medical/health expenses.
- Copayments: Fixed amounts for specific services.
- Pre-authorizations/Prior Approval: Insurer approval required before some services are covered.
- Usual, Reasonable, and Customary (URC) Charges: Maximum amount insurer pays for typical services.
- Benefit Limits: Limits on total, annual, or per-cause benefits.
Riders
- Impairment/Exclusion Riders: Exclude specific conditions from coverage.
- Guaranteed Insurability Rider: Allows the purchase of future insurance without proving insurability.
- Future Increase Option Rider: Enables increasing coverage without medical underwriting (at specific times).
Rights of Renewability
- Noncancelable: Insurer cannot cancel or change premiums during policyholder's continuous premium payments.
- Cancelable: Insurer can cancel or change premiums, coverage.
- Guaranteed Renewable: Insurer must renew as long as premiums are paid, but premiums can increase.
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Description
Test your knowledge on essential insurance policy provisions. This quiz covers key terms such as mandatory provisions, grace periods, and claim processes. Understand the rights and duties of both the insurer and the insured through various clauses and regulations.
