What are the 12 required uniform policy provisions in a health insurance policy?

Answer 1

The 12 Mandatory Uniform Provisions are:

1. Entire contract - the policy, a copy of the application, and any riders

2. Time Limit on certain defenses (incontestable) - no statement (except fraudulent) shall be used to deny a claim after the policy has been in force for at least 2 years.

3. Grace Period - a period of time after the premium due date before the policy lapses for non-payment of premium.

4. Reinstatement - allowing an insured to reinstate a premium that lapsed for nonpayment of premium if they pay past due premiums. They may require a reinstatement application to prove insurability

5. Notice of Claim - must be given in writing and is required within 20 days of loss or as soon as reasonably possible.

6. Claim Forms - must be received by the insured within 15 days after notice of claim

7. Proof of Loss - is required within 90 days of loss or as soon as possilbe

8. Time of Payment of Claims - all claims are to be paid immediately upon written proof of loss

9. Payment of Claims - death benefits are paid to the beneficiary and other benefits may be paid to insured or provider of services

10. Physical Exam & Autopsy - gives the insurer the right to examine at the insurer's expense

11. Legal Actions - Insured must wait 60 days after proof of loss before legal action can be brought against the insurer.

12. Change of Beneficiary - consent of beneficiary is not required unless beneficiary is irrevocable.

Source: AD Banker Text Book