Conformity with State Statutes
MR. WATSON: If you move from another state to our state, your policy will automatically amend or conform to our statutory requirements. Make sense?
ALL: Um-hmm.
Illegal Occupation
MR. WATSON: These are optional provisions. Illegal occupation. If you’re robbing a bank or convenient store and get shot, will your health insurance pay?
ALL: No, illegal occupation.
Intoxicants & Narcotics
MR. WATSON: What about intoxicants, what if you are drunk driving, driving high? No way. Illegal occupation and intoxicants, unless the drugs were administered by a physician.
Other Health Insurance Provisions
Insuring Clause
MR. WATSON: Let's talk about the insuring clause . What do you think is in the insuring clause?
WOMAN: Promise to pay.
MR. WATSON: Where are we going to find the insuring clause?
WOMAN: First page.
MR. WATSON: On the cover of the policy, first page. It stipulates conditions for when benefits are to be paid. Does that make sense?
ALL: Yes.
MR. WATSON: So where are we going to find the insuring clause? First page. Stupid question, isn't it?
MR. WATSON: There are two signatures on every insuring clause. Whose do you think they are? The president and the secretary of the company.
MR. WATSON: Where is the Insuring clause found?
ALL: Front page.
MR. WATSON: Very good. What two signatures are there?
ALL: President's and secretary's.
Consideration Clause
MR. WATSON: Consideration clause. Remember, consideration is just a money thing, isn't it? It states when the premiums are due and how much they are. So consideration is just the money thing. Y'all agree?
ALL: Yes.
MR. WATSON: Frequently found in the consideration clause is
- the right to renew
- the initial term of the policy, and
- the effective date.
Dependents & Conversion
MR. WATSON: Conversion privilege. If you have an individual health insurance policy, you can keep your kids covered on your plan until 26. You don’t have to, but you can. Since October of 2010, the Affordable Health Care Act mandates insurance companies, or allows you, to cover dependents up to age 26. In Florida, up to age 30. Wow!
MR. WATSON: If you have adopted children, they are treated like a natural child. Stepchildren are covered. Foster children are covered. Make sense? They can convert it later on to an individual plan of their own.
MR. WATSON: What if you have a child who is dependent on you because of a mental or physical characteristic and he's older than 26? Are they covered?
ALL: Yes. As long as they are a dependent.
MR. WATSON: Remember this, any child who reaches the limiting age but is dependent on the insured and incapable of self-support because of a mental or physical condition is allowed to be covered under their parent's policy, with no age limit.
MR. WATSON: With health insurance, newborns are covered immediately. But you have to notify the insurance company, complete an application, and pay an additional premium within a specified period.
MR. WATSON: When are newborns covered?
ALL: From the moment of birth.