| A | B |
|---|
| FL entire contract contains | policy, applications & all attachments |
| An agent does NOT | have authority to change the policy or waive any provisions |
| FL health/disability policy incontestable after it's been in force for | 2 yrs. |
| Fraudulent misstatements in the application | may be used to void the policy or deny any claim |
| Grace Period for weekly premium | no less than 7 days |
| Grace Period for monthly premium | no less than 10 days |
| Grace Period in general | 31 days |
| Full effect | if a premium is paid with the grace period coverage shall remain in |
| if health policy reinstated after it had lapsed, waiting period is _ before a claim will be covered | 10 days (1) |
| If health policy is reinstated after lapsed for nonpayment, injuries sustained from an accident will be covered | immediately |
| If insurer takes no action within __ after receiving reinstatement application, policy is consdered reinstated | 45 days (1) |
| Written notice of claim muste be given within__after the loss starts | 20 days |
| insurance company will send forms for filing proof of loss to claimanant with _ days after co. received notice of claim | 15 days |
| Written proof for any loss must be given to ins. co with __ | 90 days |
| time payment of claims allows insurers __ after receiving notice and proof of loss to pay or deny claim | 45 days (2) |
| Free-look period is __ | 10 days (2) |
| Free look period allows | policyowner time to decide whether or not to keep the policy |
| If policyowner decides not to keep the policy within free look period, | full refund will be given |
| person with Medicare has free look period of | 30 days |
| No legal action can be started within ___ after proof of loss submitted | 60 days |
| No legal action can be initiated after __ from the intial time written proof of loss | 5 years |
| advertisements for health insurance must identify the | insurer |
| insurance companies must make sure testimonials are | accurate |
| insured has a right to ___during claim process | examination |
| insurer has right to ____ after death | autopsy (where not forbidden by law) |
| insurers do not need to cover losses if insured has | engaged in felony or illegal occupation |
| change of benficiary allowed if designation is | revocable |
| policowner has right to surrender or assign the policy without | beneficiary's permission |
| with individual health insurance can't excude coverage from prexisting conditions for more than | 24 months |
| with group health insurance pre-existing condition is considerd a condition within the | previous 6 months |
| with individual health insurance pre-existing conditions are considered condition within the | previous 24 month |
| with group health insurance pre-ex. condition excluded for max | 12 months |
| with group health insurance pre-ex. conditons excluded ___ for late enrollees | 18 months |
| all employees/members of group health policy in FL must be | eligible to participate regardless of health history |
| if insured moves to different health plan, credit for fulfilling preexisting requirement on prior plan will be | transferred |
| for replacement health policy, the required replacement notice must include | notice that pre-existing conditions may not be covered |
| creditable coverage for pre-ex. conditions occurs if there has not been a break in covere of | 63 days |
| creditable coverege for individual health insurance is | 18 months (1) |
| with FL family coverage newborn coverage starts at | birth |
| with FL health plan coverage, newborn coverage needs to last at least | 18 months (2) |
| coverage needs to continue for a handicapped child beyond the usual limiting age when the child is | incapable of self-sustaining employment |
| at option of insurer, a separate converted policy may be issued to cover a | dependent |
| use of genetic testing or test results by health insurers | is prohibited |
| a small employer employs no more than this no. of employees | 50 |
| carriers must offer this to small employers | at least the standard plan |
| a small employer carrier shall renew or continue that plan at the | optin of the small employer |
| a provider of health care services for certain insureds is called a/an | Exclusive Provider Organization |
| policy that coveres a single disease or illness only | Dread disease policy |
| Employees coverd by employee group health insurance have | no minimum percentage participation |
| this avoids duplication of benefits | Coordination of benefits |
| Coordination of benefits is abbreviated | COB |
| Association plans must be | fully insured by an authorized insurer & subject to state regulationP |
| PLSHO provides limited health service in return for | prepayment |
