Mandatory Health Insurance Policy Provisions

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Across
  1. 3. If state law allows, the insurer may require insureds to submit this and is paid for by the insurer.
  2. 4. To whom all benefits are payable to upon death of the insured, if named.
  3. 5. Insurers must provide this within 15 days upon receipt of the insured's notice of a claim.
  4. 8. This is the right of the policyowner/beneficiary designated as irrevocable only. Changes may not be made to the policy without the beneficiary's permission.
  5. 9. Can not be taken prior to 60days after filing a written proof of loss, or after the expiration of 3 years after filing a written proof of loss.
  6. 11. A written document, that must be provided to the insurer within 90days of the date of loss. If not reasonably possible to furnish this within 90days, the insured has one year after the date of loss unless the insured has a legal incapacity.
  7. 12. Optional provision allowing payment of up to $1,000 in benefits to any relative of the insured or beneficiary by blood or marriage that appears to be entitled to them.
  8. 14. Receives all benefits upon death of the insured, if no beneficiary is named or the beneficiary is deceased.
  9. 15. This provision states Insurers must pay lump sum claims immediately after receiving proof of loss. Claims involving periodic payments such as disability income, must be made at least monthly.
Down
  1. 1. Written notice of claim must be given to the insurer within 20days after any occurance or commencement of any loss covered by the policy or as soon as is reasonably possible. Unless there is a continuing disability;in this case, the insured can only be required to provide proof ever 6 months.
  2. 2. This provision states that the insurance policy represents a contract between the insurer & the insured consisting of: Application, Insurance Policy, Riders (endorsements), any other papers or amendments.
  3. 6. This provision states how & whom payments are to be made.
  4. 7. This provision states after 2 years from the date of policy issue, no misstatments, except for fraudulent misstatements made by the applicant in the application, shall be used to void the policy or deny a claim for loss.
  5. 10. May require an application to be submitted, if the insurer has not dissapproved application & notified the applicant within 45days, the application is automatically approved.
  6. 13. Insurance is still enforced during this specified time following the due date of a premium payment in which the premium has not been paid.