Colorado Health Insurance Study Guide
Mandatory Uniform Provisions (Ans- Must be included in every individual accident policy, no additional provisions may be included which otherwise restrict or modify a uniform provision, designed to protect the insured's interest
Entire Contract Clause- Mandatory Uniform (Ans- Includes the policy and provisions, c a copy of the application and any riders, waivers, or endorsements
Time Limit on Certain Defenses-Mandatory Uniform (Ans- No statement or misstatement may be contested after 2 years, no time limit for fraud
Grace Period-Mandatory Uniform (Ans- Period after premium due date before policy lapse, (7-10-31) 7 days for weekly premium; 10 days for a monthly premium; 31 days of every thing else
Reinstatement Provision- Mandatory Uniform (Ans- Applies to the time frame that an insurer hasn't paid premium but wants the policy back, allows insured to reinstate by paying past due premiums, proof of insurability may be required, sickness begins after 10 days, accidents are covered immediately
- If you haven't heard back in 45 days, then the policy has been reinstated
Notice of Claim provision-Mandatory Uniform (Ans- Policy owner must notify Insurer of loss either in writing, in person or by phone w/in 20 days.
claim forms provision-Mandatory Uniform (Ans- The insurer is required to send the insured a claim form within 15 days after notice is received 1 / 2
Proof of Loss provision-Mandatory Uniform (Ans- Policy owner has 90 days from date of loss to submit proof of loss to Insurer; valid claim must be paid immediately upon receipt.
Time of Payment of Claims-Mandatory Uniform (Ans- Provides for immediate payment of the claim after the insurer receives notification and proof of loss.
Payment of Claims Provision-Mandatory Uniform (Ans- Payment of claims to the policyowner unless otherwise specified or there is an assignment of benefits(required) defines how proceeds are to be paid out + requirements to initiate death benefit claim
Physical Exam and Autopsy-Mandatory Uniform (Ans- A provision that allows an insurer, at its own expense, to have an insured physically examined when a claim is pending or to have an autopsy performed where not prohibited by law.
legal action (Ans- Insured must wait 60 days but no later than 3 years after proof of loss (POL) before legal action may be brought against the isurer
Change of Beneficiary Provision-Mandatory Uniform (Ans- Stipulates that the policy owner may change the beneficiary at any time by providing a written request to the insurer, unless the beneficiary is designated as irrevocable.
Optional Uniform Provisions (Ans- These provisions are included at the insurer's option; however, if used they must conform to the state's insurance code. These provisions are designed to protect the insurer.
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