Health Insurance Ch 3 (22%)

Front 1

Grace Period

Back 1

Premium still effective before policy lapses for non payment. Not less than 7 days for weekly premiums, 10 days for monthly premiums, 31 days for other modes.

Front 2

Reinstatement

Back 2

If a grace period lapses then, policy is reinstated if application and premium has been filed after 45 days if not blatantly denied

Front 3

Legal Actions

Back 3

Claimant may seek recovery from an insurer but must wait 60 days but no longer than 3yrs. Must first provide proof of loss within 90 days.

Front 4

Insuring Clause

Back 4

Identifies the insured and the insurance company and states what kind of loss is covered

Front 5

Stop Loss Limit

Back 5

Dollar amount beyond which the insured no longer participates in the sharing of expenses.

Front 6

Impairment Rider

Back 6

Eliminating coverage for a specifically defined pre-existing condition without increasing the premium

Front 7

Future Increase Option OR Guaranteed Purchase Option

Back 7

Allows the insured to purchase additional amounts of disability income coverage w/o evidence of insurability.

Front 8

Can businesses deduct premiums? Can individuals deduct premiums?

Back 8

Yes / No

Front 9

Can insurance companies contest a claim after two years?

Back 9

If they can prove fraud

Front 10

When is a policy reinstated if it’s applied for

Back 10

When a company says so or 45 days, whatever comes first

Front 11

How long may the claims department investigate?

Back 11

60 days

Front 12

What does URC stand for?

Back 12

Usual, reasonable, & customary

Front 13

Entire contract is what?

Back 13

Copy of application, policy, and attached riders

Front 14

Physical exam/ autopsy provision

Back 14

Insurer can exam insured as often as necessary. Mandatory part of contract

Front 15

Notice of claim provision

Back 15

Insured must notify insurer of loss within 20 days and proof after 90

Front 16

Time limit on certain defenses provision

Back 16

No claim can be denied due to misstatements (except fraud) after policy in force for 2 years

Front 17

Mistatment of age would result in what

Back 17

Adjusted premium

Front 18

Illegal occupation provision

Back 18

Claimed denied if injured during illegal act

Front 19

Illegal occupation provision

Back 19

Claimed denied if injured during illegal act

Front 20

Change of occupation provision

Back 20

Allows insurer to adjust benefits if insured changes occupation

Front 21

Consideration clause

Back 21

First page of policy, both parties give consideration

Front 22

Waiver of premium provision

Back 22

Guaranteed renewable and non cancelable. If disabled, waiver waved, if for 3-6 months. Must continue premium until benefits.

Front 23

Usual, reasonable, customary charges

Back 23

What is covered in the plan and for how much based on geographic area

Front 24

Mental, emotion, and substance abuse is usually limited to

Back 24

a maximum amount of covered outpatient treatment

Front 25

Under what conditions a policy is renewed much be starters where know the policy?

Back 25

Front page

Front 26

Under what conditions a policy is renewed much be starters where know the policy?

Back 26

Front page

Front 27

Noncancellable policy

Back 27

Policy can't be canceled and is guaranteed renewable until age 65

Front 28

Cancellable

Back 28

Insurer can cancel at any time. Is actually illegal in most states and no guarantees of continued coverage.

Front 29

Under what conditions a policy is renewed much be stated where on the policy?

Back 29

Front page

Front 30

Noncancellable policy

Back 30

Policy can't be canceled and is guaranteed renewable until age 65

Front 31

Cancellable

Back 31

Insurer can cancel at any time. Is actually illegal in most states and no guarantees of continued coverage.

Front 32

Guaranteed renewable is different from non cancelable because

Back 32

insurer CAN increase premium annually.