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11 Optional Provisio
TN Accident & Health (11 Optional Provisions)
| Term | Definition |
|---|---|
| 11 Optional Provisions | The insurer can include OR ignore any provision in this list. None is required. These OPTIONAL provisions exist for the PROTECTION OF THE INSURER. |
| Change Of Occupation Provision | 1.)If the insured "CHANGES" to a MORE HAZARDOUS OCCUPATION, the insurer's risk increases. The provision allows the insurer to reduce benefits. 2.)If the insured "CHANGES" to a LESS HAZARDOUS OCC, the provision requires the insurer to reduce the premium. |
| Misstatement Of Age Provision | When an insured "MISSTATES" their AGE on the application for insurance. (If this occurs, the insurer or beneficiary is still entitled to benefits however, the benefits payable will be those the insured's premium would have bought at the CORRECT AGE.) |
| Insurance In "THIS" Insurer Provision | 2 or MORE policies with a "SINGLE" insurer. (Limits the total coverage that the company assumes with ONE insured.) |
| Insurance With "OTHER" Insurer Provision | Coverage for the SAME RISK and expenses with "ANOTHER" insurer and has NOT notified this insurer of other coverage. (Allow an insurer to prorate the amount of benefit it will pay for an expense-covered loss if another insurer is covering the same event. |
| Insurance With "Other Insurers" Provision | Coverage with "MULTIPLE" insurers of which the primary insurer had prior knowledge. (The insurer must return premiums that are more than the amount associated with its proportion of prorated benefits.) |
| Relation Of Earnings To Insurance Provision | Avoiding over insurance by reducing the policy's income benefit amount if the insured has more insurance benefit than actual income at the time of disability. (i.e. accepts a lower paying job, additional sources of income) |
| Unpaid Premium Provision | Any PREMIUM the insured MAY NOT HAVE PAID at the time of a claim. |
| Cancellation Provision | An insurer can "CANCEL" the policy at anytime with 45 days notice. (If the insured did not pay the premium and the insurer CANCELLED the policy as a result, then the insurer must give 10 days notice to the insured.) |
| Conformity With State Statutes Provision | Addressing any of its provisions that differ from STATE law. |
| Illegal Occupation Provision | Allows the insurer to deny liability when the insured's claim arises from the insured's participation in an ILLEGAL ACTIVITY. |
| Intoxicants and Narcotics Provision | Excludes insurer liability if a covered loss results from intoxication or the illegal use of NARCOTIC DRUGS. |
Created by:
Tiphanie_Dyme
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