uniform health policy provisions

How many uniform required health insurance policy provisions are there

12

How many optional health insurance policy provisions are there

10

What is uniform policy provision number one and what does it do

Uniform policy provision number one is the entire contract /changes provision. It states that the insurance policy represents a contract between the insurer and the insured

Under uniform policy provision number one in order for something to be included in the contract it must be

In writing and attached to the policy

Under the entire contract policy provision for a change to be made, it must be approved

In writing an executive officer of the insurance company and attached as an amendment

What is uniform policy provision number? 2

The incontestability clause

For uniform policy provision number 2. How long is the incontestibility period

2 years from the date of policy issue except for fraudulent misstatements which can void the policy at any time, whenever discovered

What is uniform policy provision number? 3

Grace period

What are the acceptable grace periods under uniform policy provision number? 3

7 days for weekly premium policies

10 days for monthly premium policies

31 days for all other policies (annual, semi-annual, quarterly in)

Who chooses the time frame under uniform policy provision number? 3

The insurance company chooses the grace period, but it must always be more than the general grace period. Never less than.

What is uniform policy provision number 4

Reinstatement

How long after receiving a reinstatement application and any delinquent payment is a policy reinstated

45 days after the submission of the application

Under uniform policy provision number 4. Once a policy is reinstated, how long is the probationary period for sickness

10 days however, there is no probationary period for accident coverage

What is uniform policy provision number 5

Notice of claims

Uniform policy provision number 5 states that claims must be given to the insurer within how many days after an occurrence

20

Under uniform policy provision number 5. When a notice of claim is given to the insurer it must be given

In writing

Under notice of claim, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least 2 years, the insured shall give notice to the insurer. How often

Every 6 months of the continuance of the disability except in the case of legal incapacity

What is uniform policy provision number 6

Claim forms

Under uniform policy provision number 6 insurers must provide a claim form within how many days upon receipt of notice of claim

15 days

What is uniform policy provision number 7

Proof of loss

Under uniform policy provision number 7 written proof of loss must be provided to the insurer within how many days

Within 90 days unless it is not reasonably possible and does not invalidate or reduce the claim then proof may be filed up to one year

What is a uniform policy provision number 8

Time of payment claims

Under uniform policy provision number 8. How long does an insurer have to pay lump sum claims?

45 days

What is uniform policy provision number 9

Payment of claims

Which policy provision states? How and whom payments are to be made

Provision number 9

Policies may also include an optional provision, allowing payment of up to $1,000 in benefits to any relative of the insured or beneficiary. This is covered under which policy provision

Provision number nine payment of claims

What is uniform policy provision number 10

Physical examination and autopsy

Under uniform policy provision number 10, who pays the cost of medical exam or autopsy

If the company requires it and the state allows it, the insurer will pay all costs

What is uniform policy provision number 11

Legal actions

Under uniform policy provision number 11, no action at law can be brought to recover on the policy unless

It is prior to 60 days after filing written proof of loss or after the expiration of 3 years after filing written proof of loss

What is uniform policy provision number 12

Change of beneficiary