Insurance Underwriting Process Quiz
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Questions and Answers

What is the primary distinction between a standard consumer report and an investigative consumer report?

  • Standard reports assess risk classification, while investigative reports determine creditworthiness.
  • Investigative reports focus solely on financial history, while standard reports include personal characteristics.
  • Investigative reports are obtained through personal interviews, while standard reports rely on credit reporting agencies. (correct)
  • Standard reports require consumer notification within three days of the request, investigative reports do not.
  • According to the Fair Credit Reporting Act (FCRA), what is the consumer's right regarding information about a consumer report used in an insurance application?

  • The right to prevent the insurance company from obtaining a consumer report.
  • The right to receive the report free of charge, regardless of whether coverage is approved.
  • The right to dispute inaccuracies only after coverage has been denied.
  • The right to know if a report may be requested, regardless of whether one is actually obtained. (correct)
  • An insurance applicant is notified that an investigative consumer report has been requested. What is the timeframe in which this notification must occur?

  • Prior to the start of the investigation.
  • Within three days of when the report was initially requested. (correct)
  • Within ten business days of the report request.
  • Only if adverse action is taken based on the report.
  • What is the purpose of the Fair Credit Reporting Act (FCRA)?

    <p>To regulate the collection and use of credit information. (A)</p> Signup and view all the answers

    An underwriter classifies an applicant as 'substandard'. What does this indicate about the applicant's risk profile?

    <p>The applicant presents a higher-than-average risk due to factors like health history or occupation. (C)</p> Signup and view all the answers

    Which of the following actions is NOT a component of the underwriting process used by insurance companies?

    <p>Notification of risks (D)</p> Signup and view all the answers

    An individual is considered to be of 'preferred' risk. Which of the following characteristics would be most likely?

    <p>Maintains excellent physical condition and a healthy lifestyle. (B)</p> Signup and view all the answers

    In the context of life insurance, when must insurable interest exist for a policy to be valid?

    <p>Only at the time the policy is applied for. (A)</p> Signup and view all the answers

    Within how many days must consumers be provided with additional information about a consumer report, if requested?

    <p>Five days (D)</p> Signup and view all the answers

    Which scenario exemplifies insurable interest in life insurance?

    <p>A business partner insures the life of another partner, as their death would cause financial hardship to the business. (D)</p> Signup and view all the answers

    Which risk classification would an underwriter assign to an applicant whose risk is deemed 'uninsurable'?

    <p>Declined (A)</p> Signup and view all the answers

    What type of information does the Medical Information Bureau (MIB) maintain?

    <p>Confidential aversive information about an applicant for insurability purposes and underwriting information for life and health insurers. (B)</p> Signup and view all the answers

    Under what condition can insurers access an applicant’s information from the Medical Information Bureau (MIB)?

    <p>Only if needed for additional investigation. (C)</p> Signup and view all the answers

    According to the content, can an insurer deny an insurance policy solely based on information received from the MIB?

    <p>No, insurers cannot refuse to issue policies solely on information supplied by the MIB. (C)</p> Signup and view all the answers

    For what purpose is a consumer report used?

    <p>To determine a consumer's eligibility for credit, insurance, employment, or other authorized purposes. (C)</p> Signup and view all the answers

    What is a requirement an entity must meet to obtain a consumer report on an individual?

    <p>They must have a valid business need for the information. (A)</p> Signup and view all the answers

    Which of the following best describes the motivation behind STOLI arrangements?

    <p>To generate profit by betting on the early demise of insured individuals, with investors collecting the death benefit. (C)</p> Signup and view all the answers

    In IOLI arrangements, what is the typical agreement between the insured, the agent/broker, and the investors regarding the policy premiums?

    <p>The agent/broker loans the insured money to pay the premiums for a period, after which the investors take over the policy. (A)</p> Signup and view all the answers

    What happens to the IOLI policy if the insured survives beyond the initial 2-year loan period?

    <p>The policy is sold to investors for an amount greater than its cash value but less than its death benefit. (A)</p> Signup and view all the answers

    A health insurance policy includes 'inside limits.' What does this provision primarily regulate?

    <p>Dollar limits on specific types of medical services covered by the policy. (C)</p> Signup and view all the answers

    Which scenario best describes the 'restoration of benefits' feature in a major medical policy?

    <p>The maximum lifetime benefit is returned to its original amount after a significant portion has been used for claims. (C)</p> Signup and view all the answers

    Which of the reasons explains why STOLI and IOLI arrangements are considered ethical dilemmas?

    <p>The arrangements exploit vulnerable individuals for financial gain by those without insurable interest. (C)</p> Signup and view all the answers

    How do STOLI and IOLI differ from a standard life insurance policy?

    <p>STOLI and IOLI involve third-party investors who profit from the insured's death, unlike standard policies. (A)</p> Signup and view all the answers

    What is a primary characteristic of Health Maintenance Organizations (HMOs) concerning access to specialist care?

    <p>Insureds must first be referred to a specialist by their primary care physician (PCP). (D)</p> Signup and view all the answers

    What is the role of an agent/broker in IOLI arrangements?

    <p>To loan the insured funds to pay the premiums for a set period. (C)</p> Signup and view all the answers

    How are physicians typically compensated within a Health Maintenance Organization (HMO) model?

    <p>Capitation, a fixed payment per member per month. (B)</p> Signup and view all the answers

    Why are elderly or terminally ill individuals often the target of STOLI and IOLI schemes?

    <p>Their impending mortality makes them a more profitable investment for those gambling on life expectancy. (C)</p> Signup and view all the answers

    What best describes how Preferred Provider Organizations (PPOs) differ from Health Maintenance Organizations (HMOs)?

    <p>PPOs allow insureds to seek care from any provider, but offer reduced benefits for non-preferred providers. (C)</p> Signup and view all the answers

    In STOLI and IOLI schemes, who is the beneficiary of the life insurance policy upon the death of the insured?

    <p>The investors or strangers who initiated the arrangement. (B)</p> Signup and view all the answers

    An employer's contributions to a qualified retirement plan offer which immediate tax benefit?

    <p>The contributions are tax-deductible for the employer. (B)</p> Signup and view all the answers

    What is the tax implication for an employee who withdraws funds from a qualified retirement plan before the age of 59 ½?

    <p>Withdrawals are treated as taxable income and assessed an additional 10% penalty tax. (C)</p> Signup and view all the answers

    Under what circumstance can an employee withdraw funds from a qualified retirement plan before age 59 ½ without incurring the 10% penalty?

    <p>If the employee becomes disabled. (A)</p> Signup and view all the answers

    What is the tax consequence for failing to take the required minimum withdrawal from a qualified retirement plan at age 70 ½?

    <p>A 50% tax is assessed on the amount that should have been withdrawn. (A)</p> Signup and view all the answers

    What is a key difference between qualified and nonqualified retirement plans regarding IRS approval?

    <p>Qualified plans must be approved by the IRS, while nonqualified plans do not. (D)</p> Signup and view all the answers

    Which of the following is a defining characteristic of nonqualified retirement plans?

    <p>They can discriminate in favor of certain employees. (A)</p> Signup and view all the answers

    In the context of life insurance, what does 'survivor protection' primarily aim to provide?

    <p>Financial security for dependents upon the insured's death. (A)</p> Signup and view all the answers

    Which statement accurately compares the tax treatment of contributions in qualified vs. nonqualified retirement plans?

    <p>Qualified plan contributions are tax-deductible, while nonqualified plan contributions are not. (A)</p> Signup and view all the answers

    Which of the following statements accurately describes the funding mechanism for a Flexible Spending Account (FSA)?

    <p>FSAs are funded through a combination of employee salary reductions and potential employer contributions. (D)</p> Signup and view all the answers

    How did the Patient Protection and Affordable Care Act (ACA) impact contribution limits for Flexible Spending Accounts (FSAs)?

    <p>The ACA introduced annual contribution limits for qualified medical expense accounts, indexed annually. (D)</p> Signup and view all the answers

    What are the tax advantages associated with Flexible Spending Accounts (FSAs)?

    <p>Contributions are made pre-tax, lowering taxable income, and withdrawals are tax-free for qualified medical expenses. (C)</p> Signup and view all the answers

    Which of the following is a key characteristic of a Health Reimbursement Account (HRA)?

    <p>HRAs are funded exclusively by the employer. (A)</p> Signup and view all the answers

    What are the tax benefits associated with Health Reimbursement Accounts (HRAs) for employers and employees?

    <p>Employer contributions are tax-deductible as a business expense, and employee benefits are not taxable. (C)</p> Signup and view all the answers

    What is a key difference between Health Reimbursement Accounts (HRAs) and Flexible Spending Accounts (FSAs) regarding contribution limits?

    <p>FSAs have contribution limits, while HRAs do not. (C)</p> Signup and view all the answers

    An employee is trying to decide between enrolling in a Health Reimbursement Account (HRA) and a Flexible Spending Account (FSA). Which of the following considerations is MOST important in making this decision?

    <p>Whether the employer or employee funds the account. (B)</p> Signup and view all the answers

    Which of the following scenarios illustrates a permissible use of funds from a Flexible Spending Account (FSA)?

    <p>Paying for over-the-counter medications. (D)</p> Signup and view all the answers

    Flashcards

    Underwriting Process

    The procedure used by insurance companies to evaluate risk and determine premium rates.

    Adverse Selection

    A situation where high-risk individuals are more likely to seek insurance, potentially leading to insurer losses.

    Insurable Interest

    A financial stake in the continued life of an insured person, required when applying for life insurance.

    Categories of Insurable Interest

    Three types of people or relationships for life insurance: self, relatives, business partnerships.

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    Medical Information Bureau (MIB)

    A nonprofit organization that collects medical data for insurers to assess risk.

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    MIB Information Use

    Insurers access MIB data for insurability assessments but cannot solely deny policies based on it.

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    Consumer Reports

    Documents assessing a consumer's credit worthiness or character, used for insurance eligibility.

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    Business Need for Reports

    A valid reason required to obtain a consumer report, ensuring privacy and relevance.

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    Stranger-originated Life Insurance (STOLI)

    A life insurance policy purchased by a consumer, with a stranger as the beneficiary, aiming to profit upon the insured’s death.

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    STOLI Investor Role

    Strangers or investors who purchase STOLI policies to benefit from the death of the insured.

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    Profit from STOLI

    Strangers make money by betting the insured will die soon, minimizing premium costs.

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    Investor-originated Life Insurance (IOLI)

    A variation of STOLI where investors fund policies for elderly individuals and gain ownership after two years.

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    Loan in IOLI

    Investors often loan money to insureds to cover their premiums in IOLI arrangements.

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    Two-Year Premium Payment Period

    In IOLI, this is the time frame before investors gain ownership of the policy.

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    Ethical Dilemmas of STOLI/IOLI

    Concerns arise as investors have no insurable interest in the insured's life, complicating ethical considerations.

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    Investigative Consumer Reports

    Reports containing information on a consumer's character and reputation from personal interviews.

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    Fair Credit Reporting Act (FCRA)

    A law regulating the collection and use of credit information, enacted in 1970.

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    Consumer Reporting Agencies

    Organizations that collect and provide information about consumers' credit history.

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    Right to Request Information

    Consumers can request details about their consumer report within five days.

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    Risk Classification

    A system to categorize applicants based on their risk to insurers: preferred, standard, substandard, declined.

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    Preferred Risk

    Individuals who are above average in physical condition and present low risk to insurers.

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    Substandard Risk

    Applicants deemed high risk due to health issues or hazardous activities.

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    Inside Limits

    Dollar limits set within a policy for medical services.

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    Maximum Lifetime Benefit

    The total amount a policy will pay for an individual, usually $1 million.

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    Restoration of Benefits

    Feature allowing maximum lifetime benefit to be reset after use.

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    Health Maintenance Organization (HMO)

    Prepaid plan focusing on preventive care with in-network providers.

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    Preferred Provider Organization (PPO)

    Network of providers offering services at reduced costs with more freedom.

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    FSA

    A flexible spending account for medical expenses offered by employers.

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    FSA Contribution Limits

    Annual limits are set for how much can be contributed to FSAs.

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    HRA

    Health Reimbursement Accounts funded by employers, covering employee medical expenses.

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    Employee contributions in FSA

    Employees contribute via salary reductions to their FSA plans.

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    Employer contributions in FSA

    Employers may also contribute funds to employees' FSA accounts.

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    Tax benefits of FSA

    FSA contributions reduce taxable income and withdrawals for qualified expenses are tax-free.

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    HRA Contribution Limits

    There are no contribution limits for Health Reimbursement Accounts.

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    Tax benefits of HRA

    Employer contributions to HRAs are tax-deductible; benefits are not taxed for employees.

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    Tax-Deferred Earnings

    Interest earned on contributions isn't taxed until withdrawal.

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    Employer Contributions

    Employer's contributions are tax-deductible and not taxable to employees.

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    Employee Contributions

    Employees contribute with pre-tax dollars, lowering taxable income.

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    Withdrawal Taxation

    Withdrawals are taxed as income when taken.

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    Early Withdrawal Penalty

    Withdrawals before age 59 ½ incur a 10% penalty tax.

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    Mandatory Withdrawals

    Withdrawals must begin at age 70 ½, or face a 50% tax.

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    Nonqualified Plans

    Retirement plans without IRS approval or tax advantages.

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    Life Insurance - Survivor Protection

    Life insurance provides financial support for dependents if you die.

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    Study Notes

    Types of Policies

    • Life insurance protects against premature death
    • Whole Life (Ordinary, Limited-pay, Single-premium): Permanent protection for life
    • Variable Whole Life: Interest-sensitive, fluctuating rates. No guaranteed cash value.
    • Universal Life: Flexible premiums, policy owner can skip payments (with cash value); adjustable.
    • Term Life (level, decreasing, increasing): Temporary coverage for a set period
    • Combination Plans (Joint, Survivorship): Cover multiple lives.

    Group vs. Individual

    • Individual policies are more expensive and restrictive than group policies
    • Group policies provide coverage for many people under one policy (master policy). Individual certificates are issued per insured member.

    Traditional Whole Life

    • Ordinary (straight life): Level face amount & premiums throughout the insured’s entire life
    • Limited-pay Life: Premiums are paid for a limited time, but coverage for life, level face amount
    • Single-premium Life: Paid in a lump sum, level premiums for entire life
    • Adjustable Life: Mix of whole & term life; policies have changeable features (e.g., premiums, face amount, coverage period)

    Interest/Market-Sensitive Life Products

    • Variable Life: Policyowners earn higher investment returns on cash values
    • Universal Life (Flexible Premium Adjustable Life): The primary difference between adjustable and universal life is the ability to skip premium payments as long as cash value covers costs.

    Variable Universal Life

    • Flexible premiums, investment choices of variable life, cash value based on investment in separate account, access to policy loans and withdrawals.

    Interest-Sensitive Whole Life

    • Flexible (varying) premiums based on changing interest rate, adjustable premiums.

    Equity-Indexed Universal Life

    • Interest rate tied to the stock market. Offers higher potential cash value growth. Fixed guaranteed rate. Nonguaranteed indexed rate is often high (15%–20% or more).

    Term Life

    • Level Term: Level face amount throughout the policy period
    • Decreasing Term: Face amount decreases over the policy period
    • Return of premium (ROP): Premiums are returned to the insured if no death benefit is paid
    • Annually renewable: Level face amount with increasing premiums
    • Increasing term: Increasing face amount with level premiums

    Special Features

    • Renewable policies allow renewal without proving insurability
    • Convertible policies allow term policies to convert to permanent policies without proving insurability.

    Annuities

    • Protect against outliving savings, systematically liquidates an estate
    • Single Premium Immediate Annuity (SPIA): Lump sum, immediate payments
    • Single Premium Deferred Annuity (SPDA): Lump sum, deferred payments
    • Flexible Premium: Variable premium amount and frequency.

    Combination Plans and Variations

    • Joint Life: Pays out upon the first death of two or more people within a set policy period, after the first death, the contract does not provide additional coverage.
    • Survivorship Life: Pays benefits upon the second death in the set policy period only.

    Policy Riders, Provisions, Options, and Exclusions

    • Policy characteristics and how policies function.
    • Policy Provisions: Terms of a policy reflecting rights, duties and responsibilities
    • Options involve how policy funds are used (e.g., premium payment modes);
    • Riders modify coverage.

    Policy Riders

    • Waiver of premium: Waiving premium payments during disability
    • Guaranteed insurability: Purchasing additional permanent coverage later with no proof of insurability.
    • Pay-or benefit: Premium waiver for insured's death or disability
    • Accidental death/dismemberment: Pays benefits for accidental death or dismemberment
    • Term riders: Add term coverage to existing life policy
    • Other Insureds: Protecting other lives (e.g., spouse, children)

    Policy Provisions and Options

    • Entire contract: All parts of the contract, including riders and endorsements
    • Insuring clause: Company’s promise to pay benefits if covered loss occurs
    • Free Look Period: Time to review policy and return it
    • Consideraion Period: Payment of premium by insured in exchange for insurer's promise to pay benefits
    • Owner Rights: Provides rights of the policyowner regarding the policy
    • Beneficiary designations: Selecting beneficiaries
    • Revocable & Irrevocable: beneficiaries
    • Primary/Contingent beneficiaries: Ordered list of people who receive funds in the event of death.

    Special Features

    • Renewable Term Policies: Allow renewal without proving insurability
    • Convertible Term Policies: Allow conversion to permanent policies without proving insurability
    • Long-Term Care Riders: Insurance that covers costs of prolonged care

    Settlement Options

    • Cash Payment (Lump Sum): Not taxable
    • Life Income: Pays out installments until recipient dies
    • Interest Only: Pays interest until recipient dies
    • Fixed-period Installments: Gradual payments over a fixed period
    • Fixed-amount Installments: Fixed payments until funds are exhausted.

    Accelerated Death Benefits

    • Allows insured to receive a portion of the death benefit before death due to terminal illness

    Policy Exclusions

    • Sections that exclude certain risks or conditions from coverage based on the insurer's discretion. This protects the insurer.

    Policy Provisions, Clauses, and Riders

    • Suicide clause: Policy is voided if insured commits suicide within a certain timeframe.
    • Aviation clause: Policy is voided if the insured dies while flying (or involved with) an aircraft
    • War or Military Service clause: Policy is voided if death occurs during active military service or acts of war
    • Hazardous Occupation or Hobby: Policy is voided if death occurs as a result of hazardous occupation or hobby.

    Completing the Application, Underwriting, and Delivering the Policy

    • Application: Primary source of information for underwriting
    • Signatures (agent, applicant, and proposed insured)
    • Changes require initialing and not erasing the original writing.
    • Consequences of incomplete application: insurer may waive rights and be estopped from reasserting rights if a completed application is approved.
    • Warranties: Statements that are guaranteed to be true from the insured
    • Representations: Statements made to the best of the applicant's knowledge
    • Collecting the initial premium and issuing the receipt.
    • Replacement insurance policy: The proposed coverage replaces existing insurance coverage.
    • Disclosures (HIPAA/HIV ): Must be provided to the applicant
    • USA Patriot Act and/or anti-money laundering provisions

    Insurable Interest

    • Financial motivation to want the insured to stay alive.

    Medical Information and Consumer Reports

    • Medical Information Bureau: Collected medical information to determine individual insurability; Insurers may access information only on need.
    • Consumer Reports: Any communication about a consumer's creditworthiness or other information about their lives
    • Investigative Consumer Reports: Information from personal interviews with neighbors etc.

    Risk Classification

    • Preferred, Standard, Substandard, Declined
    • Factors include lifestyles, health, hobbies, and occupations

    Stranger-Originated Life Insurance (STOLI) and Investor-Originated Life Insurance (IOLI)

    • STOLI: Third-party agent/broker or investor purchases policy; Insured receives profit on their death
    • IOLI: Similar to STOLI, but investors loan money upfront to pay premiums to the party until the death of insured. Policy sold to investor after a set period.

    Delivering the Policy

    • Effective date of coverage: Date the policy becomes effective.
    • Explaining the policy's provisions, riders (additional terms), exclusions, and rating to the client. Insurance policy summary or policy outline is issued with the policy.

    Taxes, Retirement, and Other Insurance Concepts

    • Third Party Ownership: Policyowner has insurable interest in the life of the insured
    • Group life insurance: Purchased by businesses for employee protection. Provides benefits for family members. Employers are responsible for payment.
    • Group conversion provisions: Insured has right to convert group coverage to individual policy
    • Tax qualified plans: Retirement plans which are written in writing, permanent, favor employees, not high-paid employees, and communications are appropriate for employees.

    Other Health Insurance Concepts

    • Total, Partial, and Residual Disability: Definitions and eligibility
    • Owner's rights: include the right to change beneficiaries, and pay premiums.
    • Dependent Children Benefits: Include the right to continue coverage, and notification must be provided if a child or dependent's coverage is to continue or not.
    • Premium Payment Modes: How and to whom premiums should be paid (e.g., annually, quarterly)
    • Non-duplication/Coordination of Benefits: Determining primary/secondary insurer for covered losses (if multiple policies cover the person)
    • Tax treatment of premiums and proceeds is based on whether premiums are taxed; tax consequences of benefit payments depend on whether tax was deducted.

    Health Policy Provisions, Clauses, and Riders

    • Dread disease plans and Critical Illness plans: Cover specific illnesses
    • Hospital indemnity plans: Flat dollar benefit for each day in hospital
    • Dental; policies may exclude plans
    • Vision: Pay for eye exams, or eyeglasses/contacts (often included in group plans)

    Mandatory Provisions

    • Entire Contract: Includes policy, application, and endorsements.
    • Incontestability: Cannot contest policy after a period of time, except for fraud.
    • Grace Period: Time for paying premiums without penalty
    • Reinstatement: Policy can be reinstated after missing payment under certain conditions
    • Notice of Claim: Procedure and timeframe for submitting a claim
    • Claim Forms: Providing claim forms
    • Proof of Loss: Timeframe for submitting written documents proving loss.
    • Payment of Claims Procedures: Payment timelines and methods
    • Physical Examinations & Autopsies: Right to conduct exams
    • Legal Action Provisions
    • Beneficiary Change Provisions: Rules for changing beneficiaries.
    • Misstatement of Age Implications: How age misstatements affect benefits

    Optional Provisions

    • Change of Occupation
    • Free Look Period (or Free Look)- 10 days to review the policy (return it for a full refund)
    • Consideration Clause
    • Elimination Period: Time between when injury/sickness/disability occurs and payment begins
    • Waiver of Premium: Premium payments are waived if the person is permanently and totally disabled
    • Exclusions (list specific exclusions), Pre-Existing Conditions (limitations), Recurrent Disability (existing or new claim), Coinsurance, Deductibles, Expense Coverage,

    Other Health Insurance Concepts

    • Social Security benefits: Supplemental Security Income (SSI) is for low-income, blind, disabled, or elderly people.

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