Free Individual Accident and Health Provisions Study Guide
Connecticut Accident & Health exam — Individual Accident and Health Provisions.
Connecticut writes the uniform individual health policy provisions into Conn. Gen. Stat. 38a-483, and its minimum standards for individual policies into Regs. 38a-505. The national guide explains each provision (based on NAIC Model 180), the renewability types and the optional provisions. This page gives the Connecticut wording and numbers.
Required provisions (38a-483(a))
| Provision | Connecticut rule |
|---|---|
| Entire contract | Changes are valid only when approved by an executive officer and endorsed or attached. No agent may change the policy or waive its provisions |
| Time limit on certain defenses | Connecticut's version: the policy is incontestable, except for nonpayment of premium, after two years from the issue date |
| Grace period | At least 7 days (weekly premium), 10 days (monthly), 31 days (all others) |
| Reinstatement | Accepting a late premium without requiring an application reinstates the policy. If a conditional receipt is issued, the policy is reinstated on the 45th day unless the insurer disapproves in writing first. It covers accidents after reinstatement and sickness beginning more than 10 days later |
| Notice of claim | Within 20 days of the loss, or as soon as reasonably possible |
| Claim forms | If forms aren't furnished within 15 days, the claimant may submit proof in any written form |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible and within one year, unless the claimant lacks legal capacity |
| Time of payment | Immediately on proof. Periodic benefits at least monthly |
| Payment of claims | A facility-of-payment amount of no more than $1,000 |
| Physical exam and autopsy | At the insurer's expense while a claim is pending. Autopsy only where not prohibited by law |
| Legal actions | No suit within 60 days after proof of loss, and none more than three years after proof was required |
| Change of beneficiary | Reserved to the insured unless the designation is irrevocable. The beneficiary's consent is not needed |
- Change of occupation (38a-483(b)(1)): if the insured moves to a less hazardous job, the insurer reduces the premium and refunds the excess unearned premium pro rata.
Connecticut minimum standards (Regs. 38a-505)
- Free look: policies must state the right to return the policy within 10 days of delivery for a premium refund. Single-premium nonrenewable policies are excepted (Reg. 38a-505-10).
- Accident-only policies must say on the first page, in contrasting color or bold, that they don't pay for sickness.
- Probationary periods for sickness may not exceed 30 days (Reg. 38a-505-5(E)).
- AD&D must pay if the loss occurs within 90 days of the accident (Reg. 38a-505-9(A)(11)).
- Recurrent disability: the separation period that starts a new disability can't be longer than six months (Reg. 38a-505-9(A)(10)).
- Preexisting conditions: Connecticut bars preexisting-condition exclusions in individual and group health plans, and pregnancy is never preexisting (38a-476).
Claims
- Prompt pay: 20 days for electronic claims and 60 days for paper claims, with 15% annual interest when late (38a-816(15)).
- Same-class policyholders can't be charged different premiums or given different benefits (38a-488).
Exam traps
- Connecticut's version of the time-limit provision is incontestable after two years except for nonpayment. It has no fraud exception.
- Reinstatement with a conditional receipt happens automatically on day 45. Sickness coverage starts more than 10 days after reinstatement.
- 10-day free look on individual A&H. Medigap and Partnership LTC get 30 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.
