Merritt Personal Lines Manual: Chapter 3 The Mechanics of Health Coverage
GENERAL PROVISIONS
Entire Control and Changes -- This policy, including any attachments, is the entire contract. No one has the right to change this policy unless it is approved by one of our executive officers. The approval will be attached to the policy. No agent may change this policy in any way.
This item reiterates that every insurance policy is a separate, written contract between the policyholder and the insurance company. The policy form along with all attachments constitutes the entire contract. No changes may be made to the policy unless approved by the insurance company and attached to the policy. This is to prevent you from unilaterally altering the policy -- in form or content.
Time Limit on Certain Defenses
(1) After two years from the effective date of an insured person's coverage, no misstatement, except fraudulent misstatement, made by you in the application will be used to void the policy or to deny a claim for loss incurred.
(2) No claim for loss incurred after two years from the effective date of an insured person's coverage will be reduced or denied on the ground that a disease or physical condition had existed before the effective date unless, effective on the date loss, the disease or physical condition has been excluded from coverage by name or specific description.
This is an important item for any policyholder. After your coverage has been in effect for at least two years, no misstatement except a fraudulent misstatement made in the application may be used to void the insurance or deny coverage listed in the policy.
No claim for a loss incurred more than two years after your coverage has been in effect may be reduced or denied due to a preexisting condition unless the specific condition has been excluded by name. The preexisting condition exclusion applies to general conditions (not specified) for only two years.
An important note: If the insurance company knows about a condition when it issues a policy and wants to exclude it permanently, it must exclude it by name or description. If it does not, it must cover that condition after a period of two years.
