Free Individual Accident and Health Provisions Study Guide
Kansas Accident & Health exam — Individual Accident and Health Provisions.
The national Individual Accident and Health Provisions guide explains the uniform provisions as they appear in NAIC Model 180. Kansas enacted its own version in K.S.A. 40-2203. Subsection (A) lists the required provisions and subsection (B) lists the optional ones. Most wording follows the model. The Kansas exam asks for the numbers, and Kansas keeps an optional cancellation provision that the current model has dropped. Use this table for Kansas questions.
Required provisions (K.S.A. 40-2203(A))
| Provision | Kansas rule |
|---|---|
| Entire contract; changes | The policy plus attached papers is the whole contract. Only an executive officer can approve a change, in writing. Agents can't change the policy. |
| Time limit on certain defenses | After two years from issue, no misstatement except a fraudulent one may void the policy or deny a claim. A claim for loss starting after two years can't be denied for a preexisting condition unless it was excluded by name or specific description. |
| Incontestable alternative | A policy the insured can keep in force until at least age 50 (or for five years if issued after age 44) may use an "Incontestable" clause instead. |
| Grace period | 7 days for weekly premiums, 10 days for monthly, and 31 days for all others. A policy the insurer may refuse to renew can exclude grace if nonrenewal notice was given at least five days before the due date. |
| Reinstatement | Without approval or a written disapproval, the policy is reinstated on the 45th day after the conditional receipt. It covers accidents after reinstatement and sickness beginning more than 10 days after it. Premium can't be applied to a period more than 60 days before reinstatement. |
| Notice of claim | Within 20 days after the loss begins, or as soon as reasonably possible |
| Claim forms | The insurer furnishes forms within 15 days, or the claimant may send proof in any written form. |
| Proofs of loss | Within 90 days after the loss. Late proof is allowed if furnished as soon as reasonably possible, and no later than one year after it was due unless the claimant lacked legal capacity. |
| Time of payment of claims | Non-periodic benefits are paid immediately on proof. Periodic benefits are paid at least monthly. |
| Payment of claims | Death benefits go to the beneficiary, or to the estate if none is designated. A facility of payment clause lets the insurer pay up to $1,000 to a relative who appears equitably entitled. |
| Physical examination and autopsy | At the insurer's expense while a claim is pending |
| Legal actions | No suit until 60 days after proof of loss is furnished, and none after five years from the time proof is required |
| Change of beneficiary | A revocable beneficiary can be changed without the beneficiary's consent. |
| Cancellation by insured | The earned premium is figured on the insurer's short-rate table. |
The last row is Kansas-specific: the statute puts the insured's right to cancel (A)(13) among the required provisions.
Optional provisions (K.S.A. 40-2203(B))
- Change of occupation. Benefits adjust if the insured moves to a more hazardous job, and premium is refunded if the job is less hazardous.
- Misstatement of age. Benefits adjust to what the premium would have bought at the correct age.
- Relation of earnings to insurance. Disability benefits can be reduced when total coverage exceeds earnings. The reduction may not take total monthly benefits below $200 or the sum of the benefits, whichever is less. This provision is allowed only in a policy the insured can renew to at least age 50 (or for five years if issued after 44).
- Cancellation by insurer. Kansas keeps an optional provision letting the insurer cancel on at least five days' written notice, with a pro rata refund. The current NAIC model has no such provision, so this is a Kansas difference.
- Conformity with state statutes. A conflicting term is amended to meet the Kansas minimum.
- Illegal occupation. The insurer isn't liable for a loss to which committing or attempting a felony, or engaging in an illegal occupation, contributed.
- Intoxicants and narcotics. The insurer isn't liable for a loss sustained while the insured is intoxicated or under the influence of a narcotic not taken on a physician's advice.
Other Kansas rules
- A policy may not exclude or limit coverage because Medicaid may be available (40-2203(H)).
- A person other than the insured may apply for and own a policy on the insured if that person has a proper insurable interest (40-2203(E)).
- Advertising. Kansas adopted the NAIC accident and sickness advertising model. An ad for a policy not approved in Kansas must say "This policy is not available in Kansas" (K.A.R. 40-9-100).
- Long-term care has its own rules, covered in the Kansas Senior and Special Needs guide.
Common exam traps
- Grace periods are 7 / 10 / 31 days.
- Notice of claim is due in 20 days, claim forms in 15, and proof of loss in 90, with a one-year outer limit.
- Reinstatement is automatic on the 45th day. Sickness is covered only if it begins after 10 days.
- A suit may be filed after 60 days and no later than five years after proof is required.
- The facility of payment limit is $1,000.
- The relation of earnings floor is $200.
- Kansas still has an optional insurer cancellation provision with five days' notice.
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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.
