Free Individual Accident and Health Provisions Study Guide
Iowa Accident & Health exam — Individual Accident and Health Provisions.
Iowa puts the uniform individual health policy provisions in Iowa Code 514A.3. Renewability terms are defined in 191 IAC 36.10. The national guide explains what each provision does. These notes give Iowa's numbers and wording.
Required provisions (Iowa Code 514A.3(1))
| Provision | Iowa rule |
|---|---|
| Entire contract; changes | The policy and attached papers are the entire contract. A change is valid only if approved by an executive officer and endorsed on or attached to the policy. No agent may change the policy or waive its provisions |
| Time limit on certain defenses | After two years from issue, only fraudulent misstatements in the application can void the policy or deny a claim. A policy guaranteed continuable to at least age 50 may instead use an "incontestable" clause after two years, not counting periods of disability |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for all other modes |
| Reinstatement | If the insurer issues a conditional receipt and takes no action, the policy is reinstated on the 45th day. Accidents are covered after reinstatement; sickness only if it begins more than 10 days after. Premium accepted on reinstatement can't be applied to a period more than 60 days before reinstatement |
| Notice of claim | Within 20 days of the loss, or as soon as reasonably possible |
| Claim forms | The insurer furnishes forms within 15 days. Otherwise, written proof of loss in any form counts |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible, but no later than one year after it was due, unless the claimant lacked legal capacity |
| Time of payment of claims | Lump sums are paid immediately on proof. Periodic (disability) benefits are paid at least monthly |
| Payment of claims | Death benefits go to the named beneficiary, or to the estate if none is named. An optional clause lets the insurer pay up to $1,000 to a relative who is equitably entitled |
| Physical examination and autopsy | At the insurer's expense. Autopsy only where the law allows |
| Legal actions | No suit until 60 days after proof of loss, and none more than three years after proof was due |
| Right to return (free look) | 10 days after receipt. A returned policy is void from the beginning (Iowa Code 514A.3(1)(m)) |
Optional provisions
- Change of occupation: if the insured moves to a more hazardous job and is then injured, the insurer pays what the premium would have bought at the riskier rate. A move to a less hazardous job earns a premium reduction (Iowa Code 514A.3(2)).
- Other optional provisions include misstatement of age, other insurance and relation of earnings to insurance. They follow the uniform pattern described in the national guide.
Renewability definitions (191 IAC 36.10(1))
| Term | Meaning |
|---|---|
| Noncancelable | The insurer can't refuse renewal and can't raise rates |
| Guaranteed renewable | The insurer can't refuse renewal, but may change rates by class |
| Conditionally renewable | The insurer may refuse renewal only for stated reasons, never for declining health |
| Optionally renewable | Renewal is at the insurer's option |
Related Iowa rules
- Unfair discrimination (191 IAC 15.11):
- treating complications of pregnancy differently from other illnesses is prohibited sex discrimination;
- coverage may be limited for physical impairment, including blindness, only if actuarially justified;
- producers may not discourage applying for a child under 19 because of health.
- HIV testing requires a written release explaining the purpose and use of the test (191 IAC 15.12).
- Clean health claims are paid within 30 days. Interest of 10% a year starts on day 31 (191 IAC 15.32). Disability income is exempt from the prompt-pay rule.
- Guaranty association: disability income is protected up to $300,000 (Iowa Code 508C.3).
Common exam traps
- Iowa's time limit on certain defenses is two years.
- Proof of loss has an outside limit of one year.
- Facility of payment is capped at $1,000.
- Only an executive officer can change the contract. An agent cannot.
- Reinstatement premium can't reach back more than 60 days. Sickness coverage resumes after 10 days. Approval is automatic on day 45.
- The free look is 10 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.
