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Health Insurance Provisions Clauses and Riders
Guarateed Renewable
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Health Insurance Provisions Clauses and Riders
- Guarateed Renewable
- Irrevocable Beneficiary - policy owner not exercise certain rights.
NAIC - National Association of Insurance Comissioners - regulatory issues.
- Total Disability
Mandatory Provisions
- Protect the policy holder or beneficiary
Entire Contract
The policy, singled application, riders and amendments.
Only a executive officer of the company has the autorithy to make changes to the policy.
Grace Period
- Policy still in force even without a payment of minimum 7 days for weekly premiums, 10 days for months and 31 for other modes.
Reistatement
Takes 45 days if approved by the company.
- Sickness covered only after 10 days.
- Imediately coverage for accidents.
Change of beneficiary
- If the beneficiary is irrevocable the Policyowner needs to have his permission to do it.
Claims Procedures
- Notice of a claim is 20 days after the loss.
- Usually 15 days after claim to the insurer to provide the forms.
- 90 days to return the forms with the proof of loss. Extended to 1 year.
- 45 days is the maximum waiting period to get the payment of a claim.
Physical Examination and Autopsy
- Right of the insurer to examine and autopsy the insured.
Time Limit on Certain Defenses.
- Incontestable.
- 2 years for to the insurance company claim no statement or misstatement, except fraudulent.
Legal Actions
- 60 days from the proof of loss to wait to get on a legal action.
Misstatement of Age
- Premiums adjusted with the correct age.
Change of Occupation.
- Insurer can adjust the benefits when insured change his occupation and not increase of premiums in case of a hazardous occupation.
- Rate reduction application to less hazardous occupation.
Relation of Earnings to Insurance.
- Limit the benefit paid over the last 24 months of the insureds income amount.
Incontestability Clause
- Insurer cannot refer to any document that is not contained in the contract.
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Riders
Impairment Rider
- coverage excluded in case of pre existing condition. Even for a back problem.
Guaranteed Insurability
- Future increase and guaranteed purchase also called.
- Can also have the in the contract a limit amount to ad disability coverage without evidence of insurability and only attained by age.
Rights of Rewewability
- Must be in the face page stated that is renewable but the insurer reserves the right to not do it???
- Non cancellable - guaranteed until 65 - then after Medicare coverage but not increasing the premiuns.
- Cancellable - not common and even ilegal in many states. Company cannot do that during a claim process.
- Guaranteed Renewable - increase the policy premium on the anniversary date on a class basis, not individual.