3 - A&H Provisions Flashcards
Entire Contract Provision
- printed policy
- copy of the application
- any endorsements and/or riders
Time Limit on Certain Defenses/Incontestable
- 2 years
- unless fraudulent misstatement
Grace Period of Health
- 7 days for weekly paid policies
- 10 days for monthly paid policies
- 31 days for quarterly, semi-annually and annually paid policies
Reinstatement of Cancelled Individual Health Policy
- if a reinstatement application if filled out and no action is done on the app within 45 days it is automatically reinstated
- will have a 10 day probationary period
Notice of Claim
-20 days after the loss to make the claim
Claim Forms
-company approved claim form must be provided by the insurer to the policy-owner within 15 days
Proof of Loss
- must be submitted within 180 days
- does not have to be accepted if submitted later than 1 year after it is due
Legal Actions
-cannot sue their insurer for nonpayment until 60 days after a written proof of loss has been submitted or after 3 years from the date of filing the proof of loss
Free Look
-10 days from the date of delivery to return the policy and get a full refund of premiums paid
Optional Renewable Provision
- company can terminate the policy on the anniversary or the premium due date
- can raise premiums
Conditionally Renewable Provision
- company can terminate the policy, but only in the event of one or more conditions occurring as stated in the contract
- can raise premiums
Guaranteed Renewable Provision
- company cannot cancel the policy as long as premiums are paid and fraud does not exist
- can raise premiums
Non-Cancelable Provision
- policyowner has the right to renew the contract as long as premiums are paid and fraud does not exist
- cannot raise premiums
Factors that determine premiums in Health Insurance
- morbidity
- expense charges
- interest credits
