Card Set Information

2010-07-16 20:29:13
Policy Provisions Clauses Riders

Show Answers:

  1. What is included inn the "entire contract"?
    States that the health insurance policy, together with a copy of signed application and attached riders and ammendments.
  2. Who has the authority to change a policy provision?
  3. What are the grace periods for an individual policy?
    10 days for monthly pay policies

    31 days for all other modes
  4. If a premium has not been paid by the end of the grace period, what will happen to the policy?
    The policy will lapse (terminate)
  5. When an individual needs to file a health insurance claim, what are his/her responsibilities?
    Must have a complied with the requirements of the policy if he or she submits written proof of the occurrence, nature of the loss, and extent of loss the the insurer.
  6. Which provision states to whom the claims are to be paid?
    time of payment of claims
  7. Who decides which optional provisions are included in a policy?
    the insurance company has the option
  8. In what specific way could changing to a more dangerous occupation affect a person's insurance policy?
    • Benefits will be reduced to that which premiums paid would have purchased assuming the more hazardous occupation.
    • If the change is less hazardous occupation, the insured is entitled to apply to the insurer for a rate reduction.
  9. If the insured misstakes his/her age, how will benefits be paid?
    The application/the benefits paid will be equal to those that could have been purchased by the amout of premium paid into the policy.
  10. What is identified in the insuring clause?
    Identifies the insured, insurance copany, and what kind of loss (peril) is covered.
  11. Where is the consideration clause usually located in the policy?
    Usually located on the first page of the policy
  12. Will claims be paid for injury or sickness resulting from a insured's intoxication?
  13. What are usual, reasonable and customary charged based on?
    The average charge for that procedure in that specific geographic area.
  14. Which rider will allow the insured to purchase additional amounts of disability income coverage without evidence of insurability?
    Guaranteed Purchase Option or Future Increase Option
  15. What is the difference between a guaranteed renewable and noncancelable policy?
    • -Guaranteed Renewable
    • the insurer can increase the policy premium onthe policy anniversary date.
    • -Noncancelable
    • the insurer cannot cancel a noncancleable policy, nor can the premium be increased beyond what is stated in the policy
  16. Which renewal provision gives the insured the right to renew the policy for the life of the contract but allows the insurer to alter premiums?
    Optionally Renewable
  17. What is the difference between a conditionally renewable policy and one whose renewbility is optional?
    • Conditionally-
    • the insurer may terminate the contract only at renewal for certain conditions that are stipulated in the contract.
    • optional-
    • the insurer may cancel the policy for any reason, on certain homogeneous classes.