Free Individual Accident and Health Provisions Study Guide
Illinois Life, Accident & Health exam — Individual Accident and Health Provisions.
Illinois puts the uniform individual accident and health provisions in 215 ILCS 5/357.1–357.30, and its minimum standards in 50 Ill. Adm. Code 2007. The national guide explains what each provision does. These notes give Illinois's numbers and its extra rules.
Uniform provisions
| Provision | Illinois rule |
|---|---|
| Entire contract | The policy plus the attached application (215 ILCS 5/357.2) |
| Time limit on certain defenses | After 2 years from issue, only fraudulent misstatements can void the policy or deny a claim (215 ILCS 5/357.3) |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for all others (215 ILCS 5/357.4) |
| Reinstatement | Automatic on the 45th day after a conditional receipt unless the insurer disapproves. Accidents are covered after reinstatement; sickness only if it begins more than 10 days later (215 ILCS 5/357.5) |
| Notice of claim | Within 20 days (215 ILCS 5/357.6) |
| Claim forms | Within 15 days. Otherwise proof in any reasonable form counts (215 ILCS 5/357.7) |
| Proof of loss | Within 90 days. Late proof is accepted, but no later than one year after it was due (215 ILCS 5/357.8) |
| Time of payment | Within 30 days of proof, with 9% a year interest after the 30th day (215 ILCS 5/357.9) |
| Payment of claims | To the insured or beneficiary. The optional facility-of-payment clause allows up to $1,000 to a relative (215 ILCS 5/357.10) |
| Physical exam and autopsy | At the insurer's expense. Autopsy where the law allows (215 ILCS 5/357.11) |
| Legal actions | No suit before 60 days after proof of loss, and none after 3 years from when proof was due (215 ILCS 5/357.12) |
| Change of occupation | Benefits drop for a more hazardous job. A less hazardous job earns a lower premium and a pro rata refund (215 ILCS 5/357.15) |
| Misstatement of age | Benefits adjust to what the premium would buy at the correct age (215 ILCS 5/357.16) |
| Relation of earnings to insurance | Benefits may be reduced when total disability coverage exceeds earnings (215 ILCS 5/357.20) |
Premium notices
- The rule: a policy can't be forfeited within 6 months of default unless the insurer mailed a premium notice 15 to 45 days before the due date (215 ILCS 5/357.2).
- Not covered by the rule: policies with monthly or more frequent premiums, group and industrial policies, and optionally renewable cancellable policies.
Minimum standards (50 Ill. Adm. Code 2007)
- Free look: 10 days after delivery, with a notice on the first page. Single-premium nonrenewable policies are exempt.
- Accident policies may not have a probationary or waiting period. Accident-only policies carry a required statement in contrasting color or bold type.
- Riders that reduce benefits after issue need the policyholder's signed acceptance.
- Outline of coverage: given to individual health applicants.
- Replacement:
- Applications ask whether the coverage will replace existing accident and health insurance.
- A replacement notice is given before issue or delivery. The applicant keeps a copy, and the insurer keeps a signed copy (2007.90).
Other Illinois rules
- Misrepresentation defeats coverage only if made with intent to deceive or if it materially affects the risk (215 ILCS 5/154).
- Claim delays: a written explanation is due if a claim is unresolved after 45 days (50 Ill. Adm. Code 919.70).
- Advertising: health ads may not use words like "all," "full" or "unlimited" to exaggerate benefits. Each ad must name the actual insurer (50 Ill. Adm. Code 2002).
Common exam traps
- Illinois pays 9% interest on individual health claims paid after 30 days.
- The time limit on certain defenses is 2 years. The health free look is 10 days.
- Accident policies can't have waiting periods.
- The premium notice window is 15 to 45 days before the due date.
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.
