Free Individual Accident and Health Provisions Study Guide
Alaska Accident & Health exam — Individual Accident and Health Provisions.
Alaska writes the uniform individual health policy provisions into statute, in AS 21.51, the state's version of the NAIC model. Most work the way the national guide describes. A few Alaska details differ from what many textbooks show, and those are the likely exam questions: the monthly-premium grace period, the 10-working-day claim forms deadline, the three-year time limit on defenses, and the fact that the time-of-payment provision has been replaced by a prompt-pay law.
Required provisions
| Provision | Alaska rule |
|---|---|
| Entire contract | The policy plus the attached application is the whole contract (AS 21.51.040) |
| Time limit on certain defenses | After three years from issue, nonfraudulent misstatements can't void the policy or deny a claim. A condition not excluded by name or specific description can't be used to deny a loss beginning after three years (AS 21.51.050) |
| Grace period | At least 7 days for weekly premiums, 10 days for monthly premiums, 31 days for all other modes (AS 21.51.060) |
| Reinstatement | If the insurer gives a conditional receipt for a late premium and doesn't act, the policy is reinstated on the 45th day. After reinstatement, accidents are covered right away and sickness only if it begins more than 10 days later. Reinstatement premium can't be applied to a period more than 60 days before reinstatement (AS 21.51.070) |
| Notice of claim | Written notice within 20 days after the loss begins, or as soon as reasonably possible (AS 21.51.080) |
| Claim forms | The insurer furnishes forms within 10 working days after notice. If it doesn't, the claimant may send written proof in any form (AS 21.51.090) |
| Proof of loss | Within 90 days after the loss. Late proof is accepted if it wasn't reasonably possible to file on time, but no later than one year after it was due, absent legal incapacity (AS 21.51.100) |
| Payment of claims | Death benefits go to the named beneficiary, or to the estate if none. On the insured's written request, hospital, medical, or surgical benefits must be paid directly to the provider (AS 21.51.120) |
| Physical exam and autopsy | At the insurer's expense, autopsy where not prohibited by law (AS 21.51.130) |
| Legal actions | No suit until 60 days after proof of loss, and none after three years from when proof was required (AS 21.51.140) |
| Change of beneficiary | Reserved to the insured. The beneficiary's consent isn't needed unless the designation is irrevocable (AS 21.51.150) |
Time of payment of claims. Alaska repealed the standard time-of-payment provision (formerly AS 21.51.110). Instead, AS 21.36.495 requires a health care insurer to pay or deny a clean claim within 30 calendar days of receipt, with 15% annual interest on late claims.
Guaranteed renewable variant. A policy the insured can keep in force to at least age 50 may use a true incontestable clause, effective after three years in force during the insured's lifetime. Periods of disability may be excluded from the count if the clause says so.
Optional provisions
| Provision | Alaska rule |
|---|---|
| Change of occupation | Moving to a more hazardous job reduces benefits to what the premium would buy at the higher rate. Moving to a less hazardous job reduces the premium (AS 21.51.170) |
| Misstatement of age | Benefits are adjusted to what the premium would buy at the correct age (AS 21.51.180) |
| Other insurance in this insurer | Coverage with the same insurer over the stated maximum is void, and the excess premium is returned (AS 21.51.190) |
| Relation of earnings to insurance | Disability benefits may be cut so total coverage doesn't exceed earnings, but not below the lesser of the specified benefits or $200 a month. Allowed only in policies renewable to at least age 50, or for five years if issued after age 44 (AS 21.51.220) |
| Illegal occupation | No liability for a loss to which committing a felony or an illegal occupation contributed (AS 21.51.250) |
| Intoxicants and narcotics | No liability while intoxicated or under a narcotic, unless the narcotic was given on a physician's advice (AS 21.51.260) |
Other statutory details:
- Disability policies paying loss-of-time benefits for two years or more may require notice of continuance of disability at least once every six months (AS 21.51.080(b)).
- A family policy may cover the spouse and dependent children up to a specified age of no more than 25 (AS 21.51.020).
Renewability
- If the insurer reserves the right to refuse renewal, the grace period clause must say that written notice of nonrenewal can be given at least 45 days before the premium due date (AS 21.51.060(b)).
- Individual refusal to renew (other than accident-only policies) may take effect only at the renewal date nearest each policy anniversary, without prejudice to claims arising while the policy was in force (AS 21.51.270).
- A guaranteed renewable policy must be renewed to the stated age, with rates changed only by class (AS 21.51.400).
Application statements
- Statements in an application are representations, not warranties (AS 21.42.110).
- A misstatement prevents recovery only if it was fraudulent, material to the risk, or the insurer in good faith would not have issued the policy on the same terms.
Common exam traps
- Monthly-premium grace is 10 days in Alaska, not 31.
- Claim forms are due in 10 working days, not the 15 days in many texts.
- The time limit on defenses is three years.
- After reinstatement, sickness is covered only if it begins more than 10 days later. Accidents are covered immediately.
- Alaska uses its 30-day prompt-pay law in place of the time-of-payment provision.
- If no beneficiary is named, death benefits go to the insured's estate.
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Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
