Free Individual Accident and Health Provisions Study Guide
California Life, Accident & Health exam — Individual Accident and Health Provisions.
California requires every individual disability (health) policy to contain the compulsory uniform standard provisions in statutory language (CIC 10350 and following). They follow the model described in the national guide. A few California rules sit alongside them: a 30-day free look for buyers 65 and older, 30-day claim payment, and limits on altering applications.
Required provisions
| Provision | California rule |
|---|---|
| Entire contract | Changes are valid only if approved by an executive officer and endorsed on the policy. No agent may change it (CIC 10350.1) |
| Time limit on certain defenses | After two years, the policy is incontestable except for fraudulent misstatements (CIC 10350.2) |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for other modes (CIC 10350.3) |
| Reinstatement | Accepting a late premium without an application reinstates the policy. With a conditional receipt, the policy is reinstated on approval or on the 45th day unless disapproved (CIC 10350.4) |
| Notice of claim | Within 20 days, or as soon as reasonably possible (CIC 10350.5) |
| Claim forms | Within 15 days. Otherwise the claimant may file written proof without the forms (CIC 10350.6) |
| Proof of loss | Within 90 days. Late proof is accepted up to one year, absent legal incapacity (CIC 10350.7) |
| Time of payment | Periodic benefits at least monthly (CIC 10350.8) |
| Payment of claims | Death benefits go to the beneficiary, or the estate if none (CIC 10350.9) |
| Physical exam and autopsy | At the insurer's expense (CIC 10350.10) |
| Legal actions | No suit until 60 days after proof of loss, and none after three years from when proof was required (CIC 10350.11) |
| Change of beneficiary | No beneficiary consent is needed unless the designation is irrevocable (CIC 10350.12) |
Optional provisions include change of occupation, which pays what the premium buys at the riskier class's rates (CIC 10369.2), and misstatement of age (CIC 10369.3).
California additions
- Free look for seniors. Individual and group disability policies offered to people 65 or older must allow a 30-day examination period with a full refund (CIC 786). Disability income insurance is excluded from the broader senior article in CIC 785.
- Paying claims.
- Hospital, medical, and surgical claims are paid or contested within 30 calendar days (CIC 10123.13).
- Disability income benefits are paid within 30 calendar days after the insurer has all the information it needs (CIC 10111.2).
- Altering applications. Altering a written disability application without the applicant's written consent is a misdemeanor. Clearly marked administrative notes by the insurer are allowed (CIC 10382).
- HIV and genetic testing.
- A life or disability income insurer must get written informed consent before an HIV test, and may not decline solely for a positive result (CIC 799.02, 799.03).
- Genetic tests may not be used to decide eligibility for hospital, medical, or surgical coverage (CIC 10149).
Common exam traps
- The time limit on defenses is two years. Legal actions are barred after three years.
- Monthly-premium grace is 10 days.
- Only an executive officer, by endorsement, can change the policy.
- Buyers 65+ get a 30-day free look on disability policies.
- Health claims are paid in 30 days. Disability income is paid in 30 days after complete information.
Practice Individual Accident and Health Provisions questions All Life, Accident & Health topics
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.
