Free Individual Accident and Health Provisions Study Guide
Arizona Accident & Health exam — Individual Accident and Health Provisions.
The uniform individual health policy provisions are explained in the national guide. Arizona codifies them in A.R.S. 20-1345 to 20-1359. Two Arizona differences matter most: the time limit on certain defenses is two years, and legal actions must be brought within two years after proof of loss is required.
Required provisions
| Provision | Arizona rule |
|---|---|
| Entire contract | The policy plus attachments. A change is valid only if approved by an executive officer and endorsed or attached. No agent may change the policy or waive its provisions (20-1345) |
| Time limit on certain defenses | After two years from issue, non-fraudulent misstatements can't void the policy or deny a claim. A non-excluded preexisting condition can't be used to deny a loss beginning after two years (20-1346). A policy renewable to at least age 50 may instead use an incontestable clause effective after two years in force |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for other modes (20-1347) |
| Reinstatement | With a conditional receipt and no disapproval, reinstated on the 45th day. Sickness is covered only if it begins more than 10 days after reinstatement (20-1348) |
| Notice of claim | Within 20 days after the loss, or as soon as reasonably possible (20-1349) |
| Claim forms | Within 15 days, or the claimant may file proof in any form (20-1350) |
| Proof of loss | Within 90 days; late proof accepted up to one year, absent legal incapacity (20-1351) |
| Time of payment | Immediately on proof; periodic benefits at least monthly (20-1352) |
| Payment of claims | Loss-of-life benefits go to the beneficiary, or the estate. An optional facility-of-payment clause allows up to $1,000 to a relative (20-1353) |
| Physical exam and autopsy | At the insurer's expense; autopsy where not forbidden (20-1354) |
| Legal actions | No suit until 60 days after proof of loss, and none after two years from when proof was required (20-1355) |
| Change of beneficiary | Reserved to the insured unless the designation is irrevocable (20-1356) |
Optional provisions
- Change of occupation: benefits drop to what the premium buys at the riskier rate (20-1358).
- Misstatement of age: benefits are adjusted to the correct age (20-1359).
Arizona additions
- Disabled dependent children. A child who reaches the policy's limiting age while unable to support themselves because of a disability, and chiefly dependent on the policyholder, stays covered. Proof is due within 31 days after the limiting age (20-1342.01).
- Family continuation. When the named insured dies (or on divorce), covered family members may continue or convert coverage without evidence of insurability. They must notify the insurer and pay premium within 31 days (20-1377). This doesn't apply to disability income, AD&D, or single-term nonrenewable policies.
- Mailed premiums. A premium mailed on or before the due date is paid as of the postmark date. If the postmark is unknown, payment is presumed made five mail days before receipt (20-191).
Common exam traps
- The time limit on defenses is two years in Arizona.
- Legal actions must be filed within two years, not three.
- No agent may change the policy. Only an executive officer can, by endorsement.
- Family members have 31 days to continue coverage after the insured's death.
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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.
