Illinois Health Insurance General Exam
Study online at https://quizlet.com/_gk6uqb
1. Executive Officer Who can change a policy?
2. Entire Contract Policy + Application stapled together
3. Time Limit on Certain De- 2 year period insurer can deny claims for inaccuracy or lie. Cannot
fenses deny after 2 years EXCEPT for fraud/lies
4. Misstatement of Age & Immediately results in an ADJUSTMENT to policy benefit
Gender
5. Grace Period Based on Mode of premium payment. 7 weekly, 10 monthly, 31 all
other
6. Reinstatement 10 day probation on claims arising from sickness. Not a guarantee
7. Notice of Claims (In- within 20 days of the loss or within reason. Not to exceed 1 year.
sured)
8. Claim Forms (Insurer) within 15 days from the Notice of Claims.
9. Proof of Loss (Insured) within 90 days of the loss
10. Time Payment of Claims says by when the insurer needs to pay. generally, immediately
(Insurer)
11. Physical Exam Insurer can have you undergo a physical exam as often as reasonably
necessary. The insurer covers the cost.
12. Autopsy Autopsy's are allowed unless forbidden by state law
13. Legal Action (60-2-Sue) If the insured wants to sue for denial of a claim, they must
wait 60 days after they submitted the Proof of Loss, but no longer
than 2 years
14. Change of Occupation
, Illinois Health Insurance General Exam
Study online at https://quizlet.com/_gk6uqb
Safe Job to Dangerous Job = reduced benefits
Dangerous Job to Safe Job = reduced premium rates
15. Insurance with Other In- Prevents the insured from profiting. Saves the insurer from paying
surers twice.
16. Relations of Earning to Last 2 year earning average, never less than $200 a month.
Insurance
17. Cancellation Pro-Rata: Complete return of unearned premium
Short Rate Basis: Insurer keeps a fee for cancellation
18. Conformity with State Policy must follow the rules of the state the policy is being used in,
Statues NOT the state the policy was written in.
19. Illegal Occupation Injuries & sickness resulting from illegal occupations are NOT covered.
20. Intoxicants & Narcotics Insurer will deny the claim unless prescribed
21. Insuring Clause/Insuring Known as Promise to Pay & lists the parties of the contract.
Agreement
22. Free Look/Right to Exam- 10 day period that starts at policy delivery.
ine Medicare and Long-Term Care are 30 days.
23. Consideration of the In- Application + Premium
sured
24. Consideration of the In- Promise to Pay
surer
25. Noncancellable Cannot be canceled, premium CANNOT be increased, good until age
65
26. Guarranteed Renewable
Study online at https://quizlet.com/_gk6uqb
1. Executive Officer Who can change a policy?
2. Entire Contract Policy + Application stapled together
3. Time Limit on Certain De- 2 year period insurer can deny claims for inaccuracy or lie. Cannot
fenses deny after 2 years EXCEPT for fraud/lies
4. Misstatement of Age & Immediately results in an ADJUSTMENT to policy benefit
Gender
5. Grace Period Based on Mode of premium payment. 7 weekly, 10 monthly, 31 all
other
6. Reinstatement 10 day probation on claims arising from sickness. Not a guarantee
7. Notice of Claims (In- within 20 days of the loss or within reason. Not to exceed 1 year.
sured)
8. Claim Forms (Insurer) within 15 days from the Notice of Claims.
9. Proof of Loss (Insured) within 90 days of the loss
10. Time Payment of Claims says by when the insurer needs to pay. generally, immediately
(Insurer)
11. Physical Exam Insurer can have you undergo a physical exam as often as reasonably
necessary. The insurer covers the cost.
12. Autopsy Autopsy's are allowed unless forbidden by state law
13. Legal Action (60-2-Sue) If the insured wants to sue for denial of a claim, they must
wait 60 days after they submitted the Proof of Loss, but no longer
than 2 years
14. Change of Occupation
, Illinois Health Insurance General Exam
Study online at https://quizlet.com/_gk6uqb
Safe Job to Dangerous Job = reduced benefits
Dangerous Job to Safe Job = reduced premium rates
15. Insurance with Other In- Prevents the insured from profiting. Saves the insurer from paying
surers twice.
16. Relations of Earning to Last 2 year earning average, never less than $200 a month.
Insurance
17. Cancellation Pro-Rata: Complete return of unearned premium
Short Rate Basis: Insurer keeps a fee for cancellation
18. Conformity with State Policy must follow the rules of the state the policy is being used in,
Statues NOT the state the policy was written in.
19. Illegal Occupation Injuries & sickness resulting from illegal occupations are NOT covered.
20. Intoxicants & Narcotics Insurer will deny the claim unless prescribed
21. Insuring Clause/Insuring Known as Promise to Pay & lists the parties of the contract.
Agreement
22. Free Look/Right to Exam- 10 day period that starts at policy delivery.
ine Medicare and Long-Term Care are 30 days.
23. Consideration of the In- Application + Premium
sured
24. Consideration of the In- Promise to Pay
surer
25. Noncancellable Cannot be canceled, premium CANNOT be increased, good until age
65
26. Guarranteed Renewable
