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What is included inn the "entire contract"?
States that the health insurance policy, together with a copy of signed application and attached riders and ammendments.
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Who has the authority to change a policy provision?
policyowner
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What are the grace periods for an individual policy?
10 days for monthly pay policies
31 days for all other modes
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If a premium has not been paid by the end of the grace period, what will happen to the policy?
The policy will lapse (terminate)
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When an individual needs to file a health insurance claim, what are his/her responsibilities?
Must have a complied with the requirements of the policy if he or she submits written proof of the occurrence, nature of the loss, and extent of loss the the insurer.
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Which provision states to whom the claims are to be paid?
time of payment of claims
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Who decides which optional provisions are included in a policy?
the insurance company has the option
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In what specific way could changing to a more dangerous occupation affect a person's insurance policy?
- Benefits will be reduced to that which premiums paid would have purchased assuming the more hazardous occupation.
- If the change is less hazardous occupation, the insured is entitled to apply to the insurer for a rate reduction.
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If the insured misstakes his/her age, how will benefits be paid?
The application/the benefits paid will be equal to those that could have been purchased by the amout of premium paid into the policy.
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What is identified in the insuring clause?
Identifies the insured, insurance copany, and what kind of loss (peril) is covered.
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Where is the consideration clause usually located in the policy?
Usually located on the first page of the policy
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Will claims be paid for injury or sickness resulting from a insured's intoxication?
no
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What are usual, reasonable and customary charged based on?
The average charge for that procedure in that specific geographic area.
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Which rider will allow the insured to purchase additional amounts of disability income coverage without evidence of insurability?
Guaranteed Purchase Option or Future Increase Option
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What is the difference between a guaranteed renewable and noncancelable policy?
- -Guaranteed Renewablethe insurer can increase the policy premium onthe policy anniversary date.
- -Noncancelablethe insurer cannot cancel a noncancleable policy, nor can the premium be increased beyond what is stated in the policy
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Which renewal provision gives the insured the right to renew the policy for the life of the contract but allows the insurer to alter premiums?
Optionally Renewable
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What is the difference between a conditionally renewable policy and one whose renewbility is optional?
- Conditionally-
- the insurer may terminate the contract only at renewal for certain conditions that are stipulated in the contract.
- optional-
- the insurer may cancel the policy for any reason, on certain homogeneous classes.
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