TN Accident & Health (Common Provisions)
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| Other Common Policy Provisions | In addition to the mandatory and optional provisions, health insurance policies have other standard provisions and clauses that exist for practical purposes. These "COMMON" provisions define the policy's features, benefits, and limitations.
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| Right To Examine (Free-Look) | Lets policy owner RETURN the policy to the insurer within a limited time (10 DAYS) and receive a "FULL REFUND" of all premiums and fees paid.
(The free-look period begins WHEN THE POLICY IS DELIVERED TO THE POLICY OWNER.)
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| Insuring Clause | INCLUDED ON THE FIRST PAGE OF THE POLICY! It states the insurer's promise to pay a specified amount of benefit if a certain event occurs. DESCRIBES THE TYPE AND SCOPE OF COVERAGE, provides definitions used in the policy, and states the conditions.
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| Insuring Clause | INCLUDED ON THE FIRST PAGE OF THE POLICY! It states the insurer's promise to pay a specified amount of benefit if a certain event occurs. DESCRIBES THE TYPE AND SCOPE OF COVERAGE, provides definitions used in the policy, and states the conditions.
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| Consideration Clause | States the "CONSIDERATION" terms.
(The applicant's CONSIDERATION in the health insurance contract is the application and the first premium payment.)
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| Probationary Period | THE PERIOD THAT MUST PASS "BETWEEN" the policy's effective DATE and the TIME when losses will be covered.
(Exists for a "LIMITED TIME" AFTER a policy is FIRST ISSUED.)
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| Elimination Period | The waiting period AFTER a loss occurs BEFORE benefits begin.
(DURING THIS TIME BENEFITS ARE NOT PAID!)
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| Elimination Period | The waiting period AFTER a loss occurs BEFORE benefits begin.
(DURING THIS TIME BENEFITS ARE NOT PAID!)
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| Waiver Of Premium | Provides that the policy's PREMIUM will be "WAIVED" if the insured is disabled.
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| Policy Exclusions (Conditions that are NOT covered.) | 1. Self-Inflicted Injuries
2. War & Military Actions
3. Sickness or injury while on active duty in the armed forces
4. Cosmetic Surgery
5. Infertility Treatments
6. Noncommercial Airline Travel
7. Injuries or sickness for which workers' compensation
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| Pre-Existing Conditions | A health "CONDITION" that existed before an insurance policy was issued and is not
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| Policy Exclusions (Conditions that are NOT covered.) | 1. Self-Inflicted Injuries
2. War & Military Actions
3. Sickness or injury while on active duty in the armed forces
4. Cosmetic Surgery
5. Infertility Treatments
6. Noncommercial Airline Travel
7. Injuries or sickness for which workers' compensation
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| Pre-Existing Conditions | A health "CONDITION" that e before an insurance policy was issued and is not covered for some period of time.
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| Provisions For Renewability | The rights of the insurer to increase premiums or cancel the policy and also defines the policy owners right to "RENEW" the policy's coverage beyond the current coverage period.
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| 5 Types Of Renewal Provisions | 1. Noncancellable
2. Guaranteed Renewable
3. Conditionally Renewable
4. Optionally Renewable
5. Cancellable
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| Noncancellable Provision | The insurer guarantees that it will NOT "CANCEL" the policy nor increase the premium.
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| Guaranteed Renewable Provision | The insurer "GUARANTEES" that it will not cancel the policy, though IT DOES HAVE THE RIGHT TO INCREASE PREMIUMS.
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| Conditionally Renewable Provision | The insurer cannot cancel coverage as long as the insured meets the required "CONDITIONS". The insurer can increase the premiums.
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| Renewable At Option Of Insurer Provision | With an "OPTIONALLY RENEWABLE" provision, the insurer holds the right to cancel the policy or increase premiums on a date specified in the contract.
(This usually happens on the policy anniversary date)
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| Cancellable Provision | Allows the insurer to "CANCEL OR END" the policy at any time simply by providing written notification.
(Insurer must refund any premiums paid in advance.)
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| Term Policy Provision | Special class of health insurance written specifically to cover ONLY LIMITED periods, such as 6 months.
(i.e life events)
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| Automatic Increase Option | SIMILAR to the Cost-Of-Living-Adjustment provision, this OPTION "INCREASES" benefit amounts by a specified amount.
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| Benefit Integration | To prevent over insuring the insured, prevent malingering, and keep premiums as low as possible, some health policies "INTEGRATE" the benefits they pay with similar benefits the insured may be receiving from other sources.
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| 1.) Offer 2.) Acceptance 3.) Consideration | As a contract, a health insurance policy requires 3 things...
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