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12 Provisions Req.
TN Accident & Health (12 Required Provisions)
| Term | Definition |
|---|---|
| Entire Contract Provision | The policy, attached riders, and endorsements make up the "ENTIRE CONTRACT". Only an executive officer of the company can make changes to the policy. A producer cannot make any changes to the policy. |
| Time Limit On Certain Defenses (Incontestability) Provision | Prevents the insurer from voiding coverage due to a misstatement by the insured after a "SPECIFIC AMOUNT OF TIME" has passed. (policy cannot be voided nor a claim denied after 2-3 years.) |
| Grace Period Provision | Allows the policy holder LIMITED time BEYOND THE DUE DATE to pay the premium. (The insurer must pay any claims during the GRACE PERIOD that would normally be paid. However, the insurer can deduct the premium due from the claim amount.) |
| Reinstatement Provision | Allows a policy owner to "REINSTATE" a policy that has lapsed. (The normal REINSTATEMENT period is 3 years from the date of lapse. For a policy to be REINSTATED, all premiums that were not paid must be paid with interest.) |
| Physical Examination and Autopsy Provision | Allows the insurer to require the insured to take a "PHYSICAL EXAM" at the insurers expense. |
| Legal Actions Provision | The insured cannot take "LEGAL ACTION" against the insurer until atleast 60 days after the insured provides proof of loss. Also, the insured cannot take legal action after 3 years. |
| Change of Beneficiary Provision | Policy owner has the right to "CHANGE BENEFICIARIES" only if the BENEFICIARY is revocable (able to be changed). (If the primary BENEFICIARY dies first, then proceeds go to the contingent BENEFICIARY, if no BENEFICIARIES, it goes to the estate.) |
| Payment of Claims Provision | Details how "CLAIMS ARE PAID OUT". (Proceeds go to the beneficiary. If there is no beneficiary, proceeds go to the insureds estate. |
| Notice of Claims Provision | Requires that the insured "NOTIFY" the insurer within 20 days (or as soon as reasonably possible) after a covered loss. (It serves as a "NOTICE" for the insurer to send the insured the required CLAIMS FORMS.) |
| Claim Forms Provision | The insurer must provide "CLAIMS FORMS" for the insured within 15 days of RECEIVING a notice of claim. If the policy owner does not receive the forms within 15 days, the insured can submit a written statement describing the loss) |
| Proof of Loss Provision | The insurer must receive written "PROOF OF LOSS" within 90 days of the loss. |
| Time Payment of Claim Provision | States that the insurance company "PAY" CLAIMS "IMMEDIATELY" (45-60 days) after receiving proper proof of loss. |
| 12 Required (mandatory) Provisions | Exists primarily for the protection of the POLICY OWNER and MUST appear in ALL health insurance policies. |
Created by:
Tiphanie_Dyme
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