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32 Cards in this Set
- Front
- Back
Grace Period |
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. |
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Reinstatement |
If a grace period lapses then, policy is reinstated if application and premium has been filed after 45 days if not blatantly denied |
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Legal Actions |
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. |
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Insuring Clause |
Identifies the insured and the insurance company and states what kind of loss is covered |
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Stop Loss Limit |
Dollar amount beyond which the insured no longer participates in the sharing of expenses. |
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Impairment Rider |
Eliminating coverage for a specifically defined pre-existing condition without increasing the premium |
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Future Increase Option OR Guaranteed Purchase Option |
Allows the insured to purchase additional amounts of disability income coverage w/o evidence of insurability. |
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Can businesses deduct premiums? Can individuals deduct premiums? |
Yes / No |
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Can insurance companies contest a claim after two years? |
If they can prove fraud |
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When is a policy reinstated if it’s applied for |
When a company says so or 45 days, whatever comes first |
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How long may the claims department investigate? |
60 days |
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What does URC stand for? |
Usual, reasonable, & customary |
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Entire contract is what? |
Copy of application, policy, and attached riders |
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Physical exam/ autopsy provision |
Insurer can exam insured as often as necessary. Mandatory part of contract |
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Notice of claim provision |
Insured must notify insurer of loss within 20 days and proof after 90 |
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Time limit on certain defenses provision |
No claim can be denied due to misstatements (except fraud) after policy in force for 2 years |
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Mistatment of age would result in what |
Adjusted premium |
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Illegal occupation provision |
Claimed denied if injured during illegal act |
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Illegal occupation provision |
Claimed denied if injured during illegal act |
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Change of occupation provision |
Allows insurer to adjust benefits if insured changes occupation |
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Consideration clause |
First page of policy, both parties give consideration |
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Waiver of premium provision |
Guaranteed renewable and non cancelable. If disabled, waiver waved, if for 3-6 months. Must continue premium until benefits. |
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Usual, reasonable, customary charges |
What is covered in the plan and for how much based on geographic area |
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Mental, emotion, and substance abuse is usually limited to |
a maximum amount of covered outpatient treatment |
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Under what conditions a policy is renewed much be starters where know the policy? |
Front page |
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Under what conditions a policy is renewed much be starters where know the policy? |
Front page |
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Noncancellable policy |
Policy can't be canceled and is guaranteed renewable until age 65 |
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Cancellable |
Insurer can cancel at any time. Is actually illegal in most states and no guarantees of continued coverage. |
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Under what conditions a policy is renewed much be stated where on the policy? |
Front page |
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Noncancellable policy |
Policy can't be canceled and is guaranteed renewable until age 65 |
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Cancellable |
Insurer can cancel at any time. Is actually illegal in most states and no guarantees of continued coverage. |
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Guaranteed renewable is different from non cancelable because |
insurer CAN increase premium annually. |