Medicare Part B - Pays for doctors services and a variety of other medical services and supplies
that are not covered by hospital service. Offered to anyone w part A. May have to pay a monthly
premium. After annual deductible is met, 80% is usually paid by medicare and 20% is left.
Insuring clau...
Nevada Health and Life 2
Medicare Part B - Pays for doctors services and a variety of other medical services and supplies
that are not covered by hospital service. Offered to anyone w part A. May have to pay a monthly
premium. After annual deductible is met, 80% is usually paid by medicare and 20% is left.
Insuring clause - A general statement that identifies the basic agreement between the insurance
company and the insured, usually located on the first page of the policy. States what kind of loss (peril) is
covered
deductibles - a specified amount of money that the insured must pay before an insurance
company will pay a claim- larger the deductible the lower the premium.
Elimination period - a type of deductible that is commonly found in disability income policies. It is
a period of days which must expire after the onset of an illness or occurrence of an accident before
benefits will be payable. The longer the elimination period, the lower the cost of coverage.
coinsurance - the sharing of expenses by the policyholder and the insurance company. usually
20% insured and 80% insurer. stop-loss limit is the specified dollar amount that an insurance company
will no longer pay past
Mandatory provisions - - Entire Contract
- Grace Period: 7 for weekly premiums, 10 for monthly, 31 for other
- Reinstatement
- Change of Beneficiary
- Claims procedures: insured's duty to notify insurer in the event of a loss (within 20 days), insurer gives
insured claims forms, proof of loss within 90 days, time of payment of claims and payment of claims
(amount, how often, to whom)
- Physical examination and autopsy
- Time limit on certain defenses (incontestable) - usually can't deny a claim if it has been in force 2 years
- Legal actions: insured but wait 60 days but less than 3 years after proof of loss
, - Misstatement of age
- change of occupation
- Ilegal occupation
- Relation to earnings of insurance
Consideration clause - both parties must give some sort of valuable consideration
Probationary period - A period of time must lapse before coverage for specified conditions goes
into effect.
Pre-existing condition - conditions that existed that insured received diagnosis, advice, or
treatment for before the application for insurance.
recurrent disability - specifies the period of time that must lapse between two illnesses in order
for a new set of benefits to be available for the second illness. elimination period doesnt need to happen
again
Maximum benefits are expressed as - - Life-time limit
- Annual limit
-Per-cause limit
Impairment (exclusion) rider - Excludes coverage for specific injury/illness either temporarily or
permanently in order to eliminate pre-existing condition. ex) back injuries
Guaranteed Insurability Rider (future increase option/guaranteed purchase option) - Allows the
insured to purchase additional amounts of disability coverage without evidence of insurability.
Medicare - A federal medical expense program of health insurance for persons 65 years of age
and older even if the individual continues to work. Also available to anyone who has been title to social
security for 2 years or has kidney failure.
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