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Uniform Individual Accident Provisions Quiz
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Uniform Individual Accident Provisions Quiz

Created by
@EnchantingBluebell

Questions and Answers

What is the shortest grace period allowed for weekly premium policies?

  • 10 days
  • 14 days
  • 7 days (correct)
  • 5 days

    • Which statement is true regarding changes to a health insurance policy?

  • An insurer can make changes without the insured's consent.
  • Only the policyholder can initiate changes to the policy terms.
  • Insured must approve all changes made to the policy. (correct)
  • Changes can be made after 30 days of notice to the insured.

    • What happens if the premium is not paid by the end of the grace period?

  • The insured may reinstate coverage under certain conditions. (correct)
  • The policyholder receives a refund for the unused premium.
  • The coverage will lapse and cannot be reinstated.
  • The policy automatically renews for another term.

    • How long is the grace period for monthly premium policies?

    <p>10 days</p> Signup and view all the answers

    Which of the following is directly tied to the premium payment mode?

    <p>Grace period duration</p> Signup and view all the answers

    Within how many days must the insured provide notice of a claim after a loss occurs?

    <p>20 days</p> Signup and view all the answers

    What is the usual timeframe for an insurer to send claims forms after receiving notice of a claim?

    <p>15 days</p> Signup and view all the answers

    What happens if the claims forms are not provided by the insurer?

    <p>The claimant can submit written proof of the loss without the forms.</p> Signup and view all the answers

    What is the maximum time allowed for submitting proof of loss after a loss occurs?

    <p>1 year</p> Signup and view all the answers

    Under which condition does the one-year limit for submitting proof of loss not apply?

    <p>If the claimant is not legally competent.</p> Signup and view all the answers

    When are claims typically required to be paid following the submission of proof of loss?

    <p>Immediately</p> Signup and view all the answers

    What is the standard minimum time frame for paying disability income benefits?

    <p>Not less frequently than monthly</p> Signup and view all the answers

    To whom are claims payments made if the insured is deceased and there is no designated beneficiary?

    <p>The deceased's estate</p> Signup and view all the answers

    What does the facility of payment clause allow insurers to do?

    <p>Expedite payments for urgently needed claim funds</p> Signup and view all the answers

    What is the insurer's duty regarding proof of loss?

    <p>Receive written proof of loss from the insured</p> Signup and view all the answers

    What rights does the insurer have concerning physical examinations?

    <p>To examine the insured as often as necessary at its expense</p> Signup and view all the answers

    What happens to pending claims if the insured has assigned benefits to a hospital?

    <p>Benefits are paid to the hospital</p> Signup and view all the answers

    Regarding claims payments, which statement is NOT correct?

    <p>Payments can be delayed indefinitely if more proof is required</p> Signup and view all the answers

    Which group is responsible for claims forms and the time of payment of claim?

    <p>The insurer</p> Signup and view all the answers

    What is the time limit for an insurer to deny a claim based on misstatements made in the application?

    <p>2 years after policy issuance</p> Signup and view all the answers

    What must the insured do before bringing legal action against an insurer?

    <p>Wait 60 days after proof of loss</p> Signup and view all the answers

    In the case of a misstatement of age, how are policy benefits adjusted?

    <p>Benefits are reduced to what the premium would have bought at the correct age</p> Signup and view all the answers

    What action can an insurer take if fraud is discovered at any point during the policy's term?

    <p>Deny any claim regardless of time</p> Signup and view all the answers

    How long does a claimant have to file a lawsuit after the proof of loss?

    <p>Up to 3 years</p> Signup and view all the answers

    What can a claim for loss occurring after 2 years not be denied based on?

    <p>Pre-existing conditions not excluded from coverage</p> Signup and view all the answers

    What does the entire contract provision guarantee in a health insurance policy?

    <p>The policy, application, and amendments together constitute the entire contract.</p> Signup and view all the answers

    Who has the authority to make changes to an individual health insurance policy?

    <p>An executive officer of the insurance company.</p> Signup and view all the answers

    Which statement is true regarding the wording in individual health insurance policies?

    <p>Insurers can modify provisions as long as they remain favorable to the policyholder.</p> Signup and view all the answers

    What is the primary purpose of the provisions established under the NAIC law?

    <p>To define the rights and duties of both the insurer and the policyholder.</p> Signup and view all the answers

    Which of the following must be included in the contract as per the entire contract provision?

    <p>Riders and amendments attached to the application.</p> Signup and view all the answers

    What is a mandatory requirement of individual health insurance policies under the NAIC law?

    <p>They must have standard provisions included.</p> Signup and view all the answers

    What happens if the premium is not paid by the end of the grace period?

    <p>The policy will lapse.</p> Signup and view all the answers

    Under which condition is reinstatement automatic?

    <p>The policyholder pays the premium without needing an application.</p> Signup and view all the answers

    What is the coverage condition for accidents after reinstatement?

    <p>Coverage is immediate for accidents.</p> Signup and view all the answers

    What must the policyholder do if the beneficiary designation is irrevocable?

    <p>Obtain permission from the beneficiary.</p> Signup and view all the answers

    What is the insurer’s right regarding the reinstatement application?

    <p>They can approve or disapprove the application.</p> Signup and view all the answers

    How many days does the insurer have to refuse a conditional receipt before coverage is reinstated?

    <p>45 days</p> Signup and view all the answers

    What happens if an insured person is injured while engaged in an illegal occupation?

    <p>The insurer can deny the claim.</p> Signup and view all the answers

    Under the relation of earnings to insurance provision, how is the benefit amount calculated?

    <p>Proportional to their average income over the last 24 months.</p> Signup and view all the answers

    What is the minimum benefit that can be provided to the insured?

    <p>$200 per month.</p> Signup and view all the answers

    If benefits exceed the monthly earnings of the insured, what is the insurer required to do?

    <p>Adjust benefits and return excess premiums.</p> Signup and view all the answers

    When may the benefits be reduced on a pro rata basis?

    <p>When the total benefits exceed the insured's earnings.</p> Signup and view all the answers

    What happens to the benefits if the insured changes to a more hazardous occupation?

    <p>Benefits are reduced to what the premium would have covered for the more hazardous occupation.</p> Signup and view all the answers

    In which scenario can an insured apply for a rate reduction?

    <p>When the insured changes to a less hazardous occupation.</p> Signup and view all the answers

    Why is occupation an important consideration in underwriting health insurance?

    <p>It affects the potential risks associated with claims.</p> Signup and view all the answers

    What do health insurance policies typically include regarding changes in occupation?

    <p>A provision to adjust benefits based on the occupation change.</p> Signup and view all the answers

    If an insured misstates their age on an insurance application, what occurs?

    <p>Benefits are adjusted according to the current premium.</p> Signup and view all the answers

    Study Notes

    Mandatory Provisions

    • Uniform Individual Accident and Sickness Policy Provisions Law set by NAIC is adopted nationally, standardizing individual health insurance policies.
    • Provisions define rights and responsibilities of both insurers and policyholders; modifications must not be less favorable to the insured.

    Entire Contract

    • Health insurance policy, signed application, and amendments form the complete contract.
    • Changes require written consent from both parties and must be documented by company executives.

    Grace Period

    • Grace period allows time post-due date for premium payment before policy lapses:
      • 7 days for weekly premiums
      • 10 days for monthly premiums
      • 31 days for other modes
    • Coverage remains active during the grace period.

    Reinstatement

    • Failure to pay premiums by the end of the grace period leads to policy lapse.
    • Coverage reinstatement is automatic if premiums are accepted without an application; otherwise, company must respond to reinstatement applications within 45 days.
    • Accidents are covered immediately after reinstatement; coverage for sickness begins after 10 days.

    Change of Beneficiary

    • Policyholders may change the beneficiary anytime via written request without consent, unless designation is irrevocable.

    Claims Procedures

    • Notice of claim must be provided within 20 days of loss; agent notice equals insurer notice.
    • Insurers must supply claims forms within a specified period (commonly 15 days).
    • Proof of loss must be submitted within 90 days or within one year if legally competent.

    Time of Payment of Claims

    • Claims paid immediately upon written proof of loss; common payment timelines include 60, 45, or 30 days.
    • Disability benefits must be disbursed at least monthly.

    Payment of Claims

    • All benefits payable to the insured during their lifetime; if deceased, benefits go to beneficiaries or the estate.
    • Insurers may expedite claim payments to those with equitable entitlement through a facility of payment clause.

    Physical Examination and Autopsy

    • Insurer may examine the insured during claim processing and conduct autopsies as permitted by law.

    Time Limit on Certain Defenses (Incontestable)

    • No claims denied based on statements in the application after two years of policy duration, barring fraud.
    • Conditions or diseases not excluded cannot be used as grounds for claim denial for losses occurring after two years.
    • Legal claims against the insurer can only be made after 60 days and up to three years after proof of loss.

    Misstatement of Age or Gender

    • Benefits will be adjusted based on what the premiums would have purchased at the correct age if a misstatement occurs.

    Change of Occupation

    • Insurer adjusts benefits based on the hazard level of the insured's occupation; benefits may be reduced for more hazardous jobs.
    • Policyholders can request a rate reduction for moves to less hazardous occupations.

    Insurance Clauses

    • Benefits denied for injuries sustained during illegal acts or occupations.
    • Relation of earnings provision limits benefits to the insured's average income over the past 24 months; insurer must return unpayable premium amounts if benefits exceed average earnings while ensuring a minimum benefit of $200 per month.

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    Description

    Test your knowledge on the Uniform Individual Accident and Sickness Policy Provisions Law, established by the NAIC. This quiz covers key provisions that are standard in individual health insurance policies across states. Understand how these provisions relate to life insurance as well.

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