Free Individual Accident and Health Provisions Study Guide
Missouri Life, Accident & Health exam — Individual Accident and Health Provisions.
The national guide explains the uniform individual accident and sickness provisions. Missouri's version is RSMo 376.777. Subsection 1 holds the required provisions and subsection 2 the optional ones. Missouri's optional list still includes the traditional intoxicants and cancellation provisions, which current NAIC Model 180 no longer has. Missouri law also governs how the application is used (376.783).
Required provisions (376.777.1)
| Provision | Missouri rule |
|---|---|
| Entire contract; changes | The policy and attached papers are the whole contract. Changes need an executive officer's approval, endorsed or attached. No agent can change or waive anything (1). |
| Time limit on certain defenses | Non-fraudulent misstatements can't be used after 2 years from issue. Alternatively, a policy may use an incontestable clause effective after 3 years in force during the insured's lifetime, not counting periods of disability (2). |
| Grace period | 7 days weekly, 10 days monthly, 31 days for others (3) |
| Reinstatement | On approval, or on the 45th day after a conditional receipt unless disapproved. Covers accidents after reinstatement and sickness beginning more than 10 days later (4). |
| Notice of claim | Within 20 days of the loss, or as soon as reasonably possible. An optional version requires notice of continued disability every 6 months (5). |
| Claim forms | If forms aren't furnished, written proof of the occurrence, character and extent of the loss complies (6) |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible and within 1 year (7). |
| Time of payment | Promptly on proof (8) |
| Payment of claims | Death benefits go to the beneficiary or the estate. Up to $1,000 may be paid to a relative (9). |
| Physical exam and autopsy | At the insurer's expense. Autopsy where allowed by law (10). |
| Legal actions | Not within 60 days after proof of loss. Not after 3 years from when proof was required (11). |
| Change of beneficiary | The insured may change it without the beneficiary's consent (12) |
Optional provisions (376.777.2)
- Change of occupation: benefits are cut for a riskier job. For a safer job, the premium is lowered and the excess refunded.
- Misstatement of age: benefits are adjusted to what the premium would buy at the true age.
- Other insurance in this insurer: limits total benefits from duplicate policies with the same insurer.
- Relation of earnings to insurance: may reduce disability benefits that exceed earnings.
- Unpaid premium: deducted from a claim.
- Conformity with state statutes: conflicting terms are amended to meet the minimum.
- Illegal occupation: excludes losses from the insured's felony or illegal occupation.
- Intoxicants and narcotics: excludes losses while the insured is intoxicated or using narcotics not prescribed by a physician. Missouri still permits this provision.
- Cancellation: Missouri's statute still lists a cancellation clause, under which the insurer may cancel on the written notice the statute requires.
The application (376.783)
- The insured is bound by the application only if a copy is attached or endorsed on the policy, or furnished with any denial based on it.
- A false statement doesn't bar recovery unless it materially affected acceptance of the risk or the hazard assumed.
Common exam traps
- Time limit on certain defenses: 2 years, or an incontestable clause after 3 years (not counting disability).
- Grace periods: 7 / 10 / 31 days.
- Notice 20 days. Proof 90 days, with an outside limit of 1 year. Suit after 60 days and within 3 years.
- Missouri's optional list still includes intoxicants and cancellation clauses.
- An unattached application can't be used against the insured.
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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.
