Free Individual Accident and Health Provisions Study Guide
Minnesota Accident & Health exam — Individual Accident and Health Provisions.
The national guide explains the uniform individual accident and sickness provisions in NAIC Model 180. Minnesota enacted them in Minn. Stat. 62A.04. Subdivision 2 holds the required provisions and subdivision 3 the optional ones. The Minnesota numbers follow the model, so the key is knowing them and their statute.
Required provisions (62A.04, subd. 2)
| Provision | Minnesota rule |
|---|---|
| Entire contract; changes | The policy, endorsements and attached papers are the whole contract. A change needs an executive officer's approval, endorsed or attached. No agent may change or waive anything (2(1)). |
| Time limit on certain defenses | After 2 years from issue, misstatements other than fraudulent ones can't void the policy or deny claims for losses that start after that period (2(2)) |
| Grace period | 7 days weekly, 10 days monthly, 31 days for others (2(3)) |
| Reinstatement | On approval, or on the 45th day after a conditional receipt unless disapproved in writing. Covers accidents after reinstatement and sickness beginning more than 10 days later. Premium can't be applied to any period more than 60 days before reinstatement (2(4)). |
| Notice of claim | Within 20 days of the loss, or as soon as reasonably possible (2(5)) |
| Claim forms | If forms aren't sent within 15 days, written proof in any form complies (2(6)) |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible, and within 1 year unless the claimant lacked legal capacity (2(7)). |
| Time of payment | Non-periodic benefits are paid immediately on proof (2(8)) |
| Payment of claims | Death benefits go to the beneficiary, or the estate. Up to $1,000 may go to a relative (2(9)). |
| Physical exam and autopsy | At the insurer's expense, during a claim. Autopsy where the law allows (2(10)). |
| Legal actions | Not before 60 days after proof. Not after 3 years from when proof was required (2(11)). |
| Change of beneficiary | The insured may change the beneficiary unless the designation is irrevocable (2(12)) |
Optional provisions (62A.04, subd. 3)
- Change of occupation: benefits are reduced to what the premium buys at the riskier classification.
- Misstatement of age: benefits are adjusted to what the premium would buy at the correct age.
- Unpaid premium: deducted from a claim payment.
- Conformity with state statutes: conflicting terms are amended to meet the minimums of the insured's state of residence.
- Illegal occupation: no liability for a loss to which the insured's felony or illegal occupation contributed.
Right to cancel (72A.51)
- Buyers of individual sickness policies, nonprofit health service plan contracts and HMO contracts may cancel until midnight of the 10th day after receiving the policy. The policy is void and the full premium is refunded.
- Medicare supplement and LTC coverage are excluded from this 10-day rule. They have their own 30-day rules.
Common exam traps
- Minnesota's required provisions are in 62A.04, subd. 2, and the optional ones in subd. 3.
- Time limit on certain defenses: 2 years.
- Grace periods: 7 / 10 / 31 days. Reinstated sickness coverage starts after 10 days.
- Notice 20 days. Forms 15 days. Proof 90 days, with an outside limit of 1 year. Suit after 60 days and within 3 years.
- Relative payment cap: $1,000.
- Health free look: 10 days.
Practice Individual Accident and Health Provisions questions All 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.
