Free Individual Accident and Health Provisions Study Guide
Colorado Accident & Health exam — Individual Accident and Health Provisions.
Colorado writes the uniform individual health policy provisions directly into C.R.S. 10-16-202, with the time limits shown below. The national guide explains what each provision does (it is based on NAIC Model 180) and covers renewability types and the optional provisions. This page gives the Colorado numbers and the rules that go beyond the model.
Colorado's required provisions (C.R.S. 10-16-202)
| Provision | Colorado rule |
|---|---|
| Entire contract | The policy, endorsements and attached papers are the whole contract. A change is valid only if an executive officer approves it and it is endorsed or attached. No agent may change or waive provisions (202(2)) |
| Time limit on certain defenses | After two years from issue, nonfraudulent misstatements on the application can't void the policy or deny a claim (202(3)(a)) |
| Preexisting conditions | A claim beginning one year after issue can't be reduced or denied as preexisting. For individual disability income policies the period is two years (202(3)(b), (c)) |
| Grace period | At least 7 days (weekly premium), 10 days (monthly), 31 days (all other modes) (202(4)) |
| Reinstatement | Covers accidents after reinstatement, and sickness beginning more than 10 days after it (202(5)) |
| Notice of claim | Within 20 days of the loss, or as soon as reasonably possible (202(6)) |
| Claim forms | If the insurer doesn't furnish forms within 15 days, the claimant may submit written proof of loss in any form (202(7)) |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible and no later than one year after it was due, unless the claimant lacked legal capacity (202(8)) |
| Time of payment | Non-periodic benefits immediately on proof; periodic benefits at least monthly (202(9)) |
| Payment of claims | A facility-of-payment clause may pay up to $1,000 to a relative or other person (202(10)(b)) |
| Physical exam and autopsy | At the insurer's expense during a claim. Autopsy only where the law allows (202(11)) |
| Legal actions | No suit until 60 days after proof of loss, and none more than three years after proof was required (202(12)) |
| Change of beneficiary | Reserved to the insured, without the beneficiary's consent, unless the designation is irrevocable (202(13)) |
Other Colorado rules for individual coverage
- Prompt pay: clean claims are paid within 30 days if filed electronically or 45 days if filed on paper. All other claims within 90 days. Late payments carry 10% interest, plus a 20% penalty from day 91 (10-16-106.5).
- Disability income and Social Security: a disability policy may not reduce benefits already being paid because federal Social Security benefits increase (10-16-108(1)(d)).
- Replacement: the application must ask whether the applicant has other accident and sickness coverage in force and whether the new policy replaces it (Reg. 4-2-1, Sec. 5.A).
- Guaranty protection: the Life and Health Insurance Protection Association covers up to $300,000 for disability income and $500,000 for health benefit plans (10-20-104).
- Colorado law does not provide a general 10-day free look for individual health policies. Don't apply one by default. Medicare supplement and LTC policies have their own 30-day free look.
Exam traps
- Preexisting conditions: one year for health, two years for disability income.
- Notice 20, forms 15, proof 90, latest one year. Suit no sooner than 60 days and no later than three years.
- The beneficiary is changed by the insured, not the owner or the beneficiary.
- The grace periods are 7 / 10 / 31 days.
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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.
