What is the insuring clause in a life insurance policy?
States the scope and limits of the coverage ( "States the scope and limits of the coverage". The purpose of the insuring clause is to specify the scope and limits of the coverage provided. If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations EXCEPT
What is the insured's consideration given for a health insurance policy?
The insured's consideration given for a health insurance policy is The first premium payment and the application The standard provisions of an accident and health insurance policy require that the Policy, endorsements, and attached papers constitute the "entire contract"
How many terms are in the Wisconsin health insurance law?
63 terms tenequa_washington7 Wisconsin Health Insurance Law 33 terms samcarlson17 Health policy provisions, clauses and riders 73 terms Haunted2020 Subjects Arts and Humanities Languages Math Science Social Science Other Features Quizlet Live Quizlet Learn Explanations Flashcards Mobile Quizlet Plus Quizlet Plus for teachers Help Sign up
Which clause identifies which losses resulting from an accident or sickness?
The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the? (The Insuring clause identifies which losses resulting from an accident or sickness are insured by the policy.) In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments?
Which clause under a health insurance policy describes the limits of coverage and identifies the parties to the contract?
Which clause under a health insurance policy describes the limits of coverage and identifies the parties to the contract? The insuring clause states the scope of coverage, the promise to pay benefits under the terms of the policy, any conditions within the policy, and any definitions required by law.
Which of the following provisions specifies how long a policy owners health coverage will remain in effect if the policy owner does not pay the premium when it is due?
The grace period is the additional period of time after a premium payment is due that will allow the policy to remain in force in the event of nonpayment.
Which of the following statements describes the purpose of the insuring clause in health and accident policies?
The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is? Time Limit on Certain Defenses. Which of the following statements describes the purpose of the Insuring clause in Health and Accident policies? States the scope and limits of the coverage.
What is payment of claims provision?
A time of payment of claims provision states the number of days that the insurance company has to pay or deny a submitted claim. This provision is included to minimize the amount of time that a policyholder has to wait for his/her payment or for a decision about his/her claim.
What provision states that the policy and the application shall constitute the entire contract between the parties?
The entire contract provision is also referred to as the entire contract clause. This provision states that the policy and a copy of the application constitutes the entire contract between the insurer and the insured.
What is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
According to the Mandatory Uniform Policy Provisions, the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid is 31 days.
What is the benefit clause?
The beneficiary clause in a financial product or contract designates who will receive the associated assets attached to that product or vehicle upon their death. Named beneficiaries are those individuals or entities that a benefactor names in a trust, life insurance policy, or retirement plan.
What is the insurability clause?
An incontestability clause in most life insurance policies prevents the provider from voiding coverage due to a misstatement by the insured after a specific amount of time has passed. A typical incontestability clause specifies that a contract will not be voidable after two or three years due to a misstatement.
What is in the insuring clause?
One is the insuring clause, in which the insurer agrees to pay on behalf of the insured all sums that the insured shall become legally obligated to pay as damages because of bodily injury, sickness or disease, wrongful death, or injury to another person's property.
What are policy provisions?
Policy provisions are clauses in an insurance contract that lay out the exact conditions for which coverage is provided and for what amounts, along with exclusions and other restrictions.
What is payment of claim in insurance?
If an insurer pays a claim, it pays money to a policyholder because a loss or risk occurs against which they were insured.
What is the purpose of the coordination of benefits provision in group health insurance?
What is the purpose of the coordination of benefits clause in group health plans? The coordination of benefits (COB) provision in group health plans prevents duplicate benefit payments to insureds who have coverage under more than one group insurance plan.
What is the provision that defines to whom the insurer will pay benefits to?
The provision that defines to whom the insurer will pay benefits to is called. Payment of Claims (Correct.) The Payment of Claims provision in a Health Insurance policy states to whom claims will be paid.
What is the purpose of the insuring clause?
The purpose of the insuring clause is to specify the scope and limits of the coverage provided. If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations EXCEPT.
What is a waiver of premium rider?
Waiver of Premium rider ( "Waiver of Premium rider". If a policyowner covered under an accident and health policy wanted to ensure the policy will continue if they ever become totally disabled, they would want to add a waiver of premium rider.
What happens after an insured becomes totally disabled?
The waiver of premium provision keeps the coverage in force without premium payments if the insured has become totally disabled as defined in the policy.
What is an insurance policy insuring?
Insuring ( "Insuring". In an Accident & Health policy, the insuring clause states the amount of benefits to be paid. In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments. After an insured has become totally disabled as defined in the policy ...
What is a change of occupation provision?
Change of occupation provision (Correct.) The change of occupation provision allows an insurer to adjust policy benefits and/or rates if the insured has changed to a more hazardous occupation. An insurance company receives E’s application for an individual health policy.
What is an exclusion in health insurance?
excluded by the insurer in the contract provisions (Correct.) An exclusion is a provision that entirely eliminates coverage for a specified risk, such as an act of war or aviation.
What is a K policy?
K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the either class of insureds. This type of policy is considered. guaranteed renewable. The clause in an Accident and Health policy which defines the benefit amounts the insured will pay is called the.
Can an insurer renew an optionally renewable health policy?
With Optionally Renewable Health policies, the insurer may. review the policy annually and determine whether or not to renew it. An insurer receives proof of loss for an acceptable medical expense claim under an Individual Health Insurance Policy. Under the Time of Payment of Claims provision, the insurer MUST pay the benefits.
What is the insured's consideration given for a health insurance policy?
The insured's consideration given for a health insurance policy is. The first premium payment and the application. The standard provisions of an accident and health insurance policy require that the. Policy, endorsements, and attached papers constitute the "entire contract".
What is guaranteed renewable provision?
A Guaranteed Renewable provision allows. Premiums which can only be increased per rate class. Tim is covered by an accident and health insurance policy that may not be changed in any way by the insurer up to a stated age, as long as the premiums are paid.
How long after insurance premium is due do you file a claim?
An insured files for an accident and health insurance policy claim eight days after the premium due date. The benefit payable is $500 and the overdue premium is $200.
Is James covered by insurance?
The unpaid premium may be subtracted from the reimbursement. James is covered with health insurance by two different insurers. The "insurance with other insurers" provision in an individual health insurance policy allows an insurer to pay benefits to the insured on a pro-rata basis when.
What is an exclusion clause in an insurance policy?
Excluded by the insurer in the contract provisions. Because an exclusion is a provision that entirely eliminates coverage for a specified risk, such as an act of war or aviation.
How long does a policy last after it has been in force?
Claim will be paid and coverage will remain in force. Because After a policy has been in force for 2 (sometimes 3) years, it enters the incontestable period, in which the insurer may not deny a claim based on information not disclosed at the time of application.
What is notice of claims?
The Notice of Claims provision spells out the insured's duty to provide the insurer with reasonable notice in the event of a loss.
What is the entire contract?
The Entire Contract provision states that the health insurance policy, together with a copy of the signed application and attached riders and amendments, constitutes the entire contract. An assignment of benefits of a Health Policy. Transfers payments to someone other than the policy owner.
Why is neck injury considered a disability?
Because an assignment of benefits of a Health Policy transfers payments to someone other than the policy owner. A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior.
Can you increase your health insurance premiums at renewal?
Premiums may increase at time of renewal. A Conditionally Renewable Health Insurance policy can increase premiums at time of renewal. An insurer must provide an insured with claim forms within __ days after receiving notice of a loss. 15 [days].
Does an insurer have to pay medical expenses?
An insurer receives proof of loss for an acceptable medical expense claim under an Individual Health Insurance Policy. Under the Time of Payment of Claims provision, the insurer MUST pay the benefits. Immediately. Because under the Time of Payment of Claims provision, the insurer must pay the benefits immediately after receiving proof of loss.