Free Individual Accident and Health Provisions Study Guide
Indiana Life, Accident & Health exam — Individual Accident and Health Provisions.
Indiana puts the uniform individual accident and health provisions in IC 27-8-5-3: the required provisions in subsection (a) and the optional ones in subsection (b). The free look is in IC 27-8-5-20. The national guide explains what each provision does. These notes give Indiana's wording and numbers.
Required provisions (IC 27-8-5-3(a))
| Provision | Indiana rule |
|---|---|
| Entire contract; changes | The policy, endorsements and attached papers are the entire contract. Changes need an executive officer's approval, and no producer may change or waive provisions |
| Time limit on certain defenses | After two years, nonfraudulent misstatements can't void the policy or deny a claim |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for all others |
| Reinstatement | Accepting a premium without requiring an application reinstates the policy. With a conditional receipt, reinstatement is automatic on day 45 unless disapproved. Sickness is covered only if it begins more than 10 days after reinstatement |
| Notice of claim | Within 20 days, or as soon as reasonably possible |
| Claim forms | If forms aren't furnished, written proof of the loss within the proof-of-loss period counts |
| Proofs of loss | Within 90 days. Late proof is accepted, but no later than one year after it was due, unless the claimant lacked legal capacity |
| Payment of claims | Death benefits go to the beneficiary or the estate. Facility of payment is allowed up to $1,000 |
| Physical exam and autopsy | At the insurer's expense. Autopsy where the law allows |
| Legal actions | No suit before 60 days after proof of loss, and none after three years |
| Change of beneficiary | Belongs to the insured unless the designation is irrevocable. No beneficiary consent is needed |
| Guaranteed renewability | A required statement: "In compliance with the federal Health Insurance Portability and Accountability Act of 1996, renewability is guaranteed" (IC 27-8-5-3(a)(13)) |
Optional provisions (IC 27-8-5-3(b))
- Change of occupation:
- More hazardous job: benefits drop to what the premium buys at the riskier rate.
- Less hazardous job: the premium is lowered and the excess refunded from the later of the change or the last anniversary.
- Misstatement of age: benefits are what the premium would buy at the correct age.
- Unpaid premium: may be deducted from a claim.
- Conformity with state statutes: any provision that conflicts with the law of the insured's state is amended to meet that law.
- Illegal occupation: losses contributed to by committing a felony or working in an illegal occupation may be excluded.
Free look and other rules
- Free look: 10 days from delivery, with the notice on the first page. Policies sold by direct response get 30 days (IC 27-8-5-20).
- Advertising: a money-back offer doesn't cure a misleading ad, and must allow at least 10 days to return the policy (760 IAC 1-18-10).
- The insurer must be clearly identified.
- Special enrollment offers can't be repeated within six months.
- Advertising files are kept three years.
- Cancellation for health: cancelling an individual's coverage between renewal dates because of a medical condition is an unfair practice (IC 27-4-1-4(a)(17)).
- Genetic testing and HIV: see the Medical Plans guide.
Common exam traps
- Indiana's free look is 10 days, but 30 days for direct response sales.
- The time limit on certain defenses is two years. Proof of loss has an outer limit of one year.
- Indiana requires a HIPAA guaranteed-renewability statement.
- Only an executive officer can change the contract.
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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.
