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owners rights - -if an individual health under multiple group health insurance plans. the
insurance policy provides a death benefit, the provision limits the total amount of claims paid
policyowner will be able to designate a from all insurers covering the patient to no more
beneficiary and, unless the beneficiary than the total allowable medical expenses
designation is irrevocable, to change the
beneficiary. the power to change the beneficiary
is provided in the change of beneficiary
provision. the policyowner also has the right to primary plan - -the plan that is responsible
make any other change without the consent of for providing the full benefit amounts as it
the beneficiaries. specifies.
dependent children benefits - -the group secondary or excess plan - -once the
coverage may be extended to cover the insureds primary plan has paid its full promised benefit,
dependents. eligible dependents include the the insured submits the claim to the secondary
insureds children, spouse, dependent parents, provider for any additional benefits payable
and anyone else upon which dependency can be (including deductibles and coinsurance). in no
proven. case will the total amount the insured receives
exceed the costs incurred or the total maximum
every policy providing coverage for a dependent benefits available under all plans.
child until a specified age will not terminate that
coverage if the child is dependent upon the
insured and is incapable of self support because
of physical or mental handicaps. proof of the loss - -amount covered by primary plan =
dependency is required within 31 days of the amount covered by secondary plan
child attaining the maximum age. upon request,
proof of dependency is required annually after a
2 year period following attainment of maximum
age occupational coverage - -provides benefits
for illness, injury or disability resulting from
accidents that occur on or off the job
modes of premium payment - -higher
frequency of payments = higher premium
payments nonoccupational coverage - -only covers
claims that result from accidents or sickness
occurring off the job
nonduplication and coordination of benefits -
-the purpose of the coordination of benefits
(COB) provision, found only in group health personally owned health insurance - -
plans, is to avoid duplication of benefit payments premium payments on personally owned
and overinsurance when an individual is covered disability income policies are non deductible by
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