Shared Flashcard Set

Details

Texas Life and Health
Health Policy Provisions, Clauses, and Riders
41
Finance
Professional
08/06/2004

Additional Finance Flashcards

 


 

Cards

Term
mandatory;optional;insured
Definition
The ____________ provisions are designed to protect the insured against potential abuses by the insurance company. The __________________ provisions allow the insurance company to protect itself from potential abuses by the __________________________.
Term
executive officer;agent/producer
Definition
The Entire Contract provision states that only an ________________ of the company has the authority to make changes to the policy. It also states that no __________________ has the authority to modify the policy or to waive a provision.
Term
7 days;10 days;31 days
Definition
The Grace period provision provides a grace period of ______________ for a monthly premium policy, _____________________ for a monthly premium policy, and _______________ for policies with any other premium mode.
Term
45 days
Definition
Under reinstatement, if the insured has not been refused coverage by the company within _____________________ of the conditional receipt, coverage is automatically reinstated.
Term
change of beneficiary
Definition
If a Medical Expense policy has an AD&D rider, the company will include the ____________________________ provision.
Term
20 days; notice of claim
Definition
The policyowner has _____________________ from the date of loss to provide the company _______________________.
Term
15 days;claim forms
Definition
That the company has a time limit of _________________________ to send the appropriate forms to the insured after being notified of a claim is contained in the _____________________ provision.
Term
90 days;reasonably possible;proof of loss
Definition
The time limit of __________________ or as soon thereafter as ____________________ for the insured to send the completed claim forms back to the insurance company is contained in the __________________________ provision.
Term
physical exam/autopsy
Definition
The __________________ provision gives the company the right to examine the insured or conduct an autopsy.
Term
time payment of claims;immediately;at least monthly
Definition
The ________________ provision states the insurance company must pay medical expense claims _______________________ and disability income benefits __________________________.
Term
payment of claims
Definition
The ____________________ provision states to whom claims will be paid.
Term
2 years;time limit on certain defenses
Definition
The provision that states that no misstatement made by the applicant on the application can be used to void the coverage after a period of___________________ is the _________________________________________________ provision.
Term
60 days;3 years
Definition
Legal action against a company may not be started sooner than _________________ after the submission of written proof of loss, and must not be delayed more than _______________________.
Term
change of occupation;more hazardous
Definition
Under the ___________________________________ provision, if the insured changes to a __________________________ occupation and fails to notify the company, only the benefits his premium would have purchased will be paid.
Term
misstate your age
Definition
If you ______________________________ at time of application, then the benefits will be adjusted to pay what the premiums would have purchased at the correct age.
Term
illegal occupation
Definition
The ______________________ provision denies benefits if the insured is injured while committing a crime or involved in any criminal activity.
Term
insuring clause
Definition
The identity of the insured, the insurance company and the kind of loss covered is found in the ______________________.
Term
10 days;free look
Definition
The period of time you have to examine your policy after delivery is _____________ and is found in the ______________________________ provision
Term
consideration;premium;statements on the application;promise to pay
Definition
The ___________________________ clause clarifies that both parties to the contract provide something of value. The insured brings the __________________ and ________________; the company brings its ______________________.
Term
probationary period
Definition
The period of time that must lapse before coverage goes into effect for specified conditions is referred to as the ___________________.
Term
elimination period
Definition
The time deductible that is usually found in Disability Income policies is called the _______________________.
Term
waiver of premium;total disability;3 to 6
Definition
____________________________ is usually found in Disability Income policies. The insured must meet the company's definition of_________________________ and satisfy a waiting period of___________ months.
Term
preexisting condition
Definition
A condition that exists before the date of the policy for which coverage does not apply for a period of time is called a _______________________.
Term
recurrent disability
Definition
The _________________________________ provision specifies the period of time that must lapse between two illnesses in order for a new set of benefits to be available for the second illness.
Term
coinsurance;deductable;majority
Definition
Major Medical policies have a _______________________ provision. After the insured satisfies the ___________________, the company will usually pay the ______________________ of the expenses.
Term
stop loss;100%;covered
Definition
A _____________________ is a medical expense policy feature stating that once the total costs have exceeded a specific amount; the insurance company pays ____________ of all ___________________expenses.
Term
deductable
Definition
A _____________________ is a specific dollar amount that the insured must pay before the insurance company will pay the policy benefits.
Term
annual
Definition
A deductible that only applies one time per year (either per person or per family) is called an ____________deductible.
Term
per occurence
Definition
A deductible that is charged with each claim is called a _______________________________ deductible.
Term
common accident
Definition
The ______________________________ provision states that when more than one family member is injured in a single accident, only one deductible will apply for all family members involved in the same accident.
Term
integrated deductable
Definition
Supplemental Major Medical policies can have an ________________________________
Term
carry over
Definition
The _______________________________ provision allows the insured to apply his incurred expenses for the last three months of a calendar year to the next year's annual deductible.
Term
Exclusions;Reductions
Definition
________________________ are causes of loss that are not covered and will have no benefits payable. _________________ decrease the benefits payable under the policy.
Term
impairment rider
Definition
An ______________________ will eliminate coverage for a specifically defined preexisting condition.
Term
guaranteed insurability;overinsurance
Definition
The _______________________ rider and is usually found in Disability Income policies. To prevent ____________________, the insured must meet an earnings test prior to each purchase.
Term
non-cancellable;disability
Definition
If the insurance company cannot cancel the policy or increase the premium, the insured has a ________________ policy. This renewal provision is usually found in __________________ policies.
Term
cancellable
Definition
With a ___________________ policy, the company can decide to cancel the policy at any time.
Term
guaranteed renewable;medical expense
Definition
If the insurance company cannot cancel the policy however they reserve the right to adjust the premium, the insured has a _________________________________ policy. This renewal provision is usually found in _________________ policies.
Term
conditionally renewable
Definition
With a _____________________________________ policy, the company may terminate the contract only for certain conditions that are stated in the contract and the premiums may be increased.
Term
optionally renewable;policy anniversary date / premium due date
Definition
If the company can cancel the policy for any reason whatsoever, the insured has an _______________________ policy. The company can only make this decision on the ____________________.
Term
Period of time
Definition
____________________________ gives the insured no renewability rights whatsoever. When the policy expires, the insured must purchase another policy.
Supporting users have an ad free experience!