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12.0 Individual Policy Provisions

Learning Objectives​

  1. Identify and describe the 12 Mandatory Uniform Health Policy Provisions
  2. Recognize and explain each Optional Uniform Provision found in individual health insurance policies
  3. Define and distinguish the Free Look, Insuring, and Consideration clauses
  4. Differentiate among the various types of policy renewal provisions
  5. List and explain the cost-containment features associated with Managed Care plans
  6. Explain the purpose and function of the Impairment Rider, Guaranteed Insurability Rider, and Multiple Indemnity Rider

Overview​

The purpose of this chapter is to explain the provisions and clauses that promote consistency and continuity among health insurance policies. Because health insurance contracts are not standardized, Mandatory Uniform Provisions are required to protect the interests of the insured. In addition, Optional and Standard Provisions further define the rights and responsibilities of both the insurer and the insured. The provisions discussed in this chapter apply specifically to individual accident and health insurance policies, including medical expense coverage, disability income insurance, Medicare Supplement (Medigap) policies, and Long-Term Care insurance.