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Details Title: Texas Life and Health Description: Health Policy Provisions, Clauses, and Riders Total Flash Cards: 41 Created: 08/06/2004 15:09:21	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
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.