Free Individual Accident and Health Provisions Study Guide
Mississippi Accident & Health exam — Individual Accident and Health Provisions.
The national guide explains the uniform individual accident and sickness provisions in NAIC Model 180. Mississippi enacted them in Miss. Code 83-9-5. Mississippi changes two key provisions. Notice of claim is 30 days, not 20. The time of payment provision carries Mississippi's prompt-pay deadlines and a 3% monthly interest penalty.
Required provisions (83-9-5(1))
| Provision | Mississippi rule |
|---|---|
| Time limit on certain defenses | After 2 years from issue, non-fraudulent misstatements can't void the policy. A claim starting after 2 years can't be reduced or denied because a condition not excluded by name existed before the effective date ((1)(b)). |
| Grace period | 7 days weekly, 10 days monthly, 31 days for others ((1)(c)) |
| Reinstatement | On approval, or on the 45th day after a conditional receipt unless the insurer disapproves. Covers accidents after reinstatement and sickness beginning more than 10 days later ((1)(d)). |
| Notice of claim | Written notice within 30 days of the loss, or as soon as reasonably possible ((1)(e)) |
| Claim forms | If forms aren't sent within 15 days, written proof describing the loss complies ((1)(f)) |
| Proof of loss | Late proof is accepted if timely proof wasn't reasonably possible, but no later than 1 year after it was due unless the claimant lacked legal capacity ((1)(g)) |
| Time of payment | Clean claims are paid within 25 days if electronic, or 35 days on paper. Corrected claims are paid within 20 days. Late payments bear 3% per month. Bad faith exposes the insurer to up to 3 times the unpaid benefits ((1)(h)). |
| Physical exam | At the insurer's own expense, as often as reasonably required while a claim is pending ((1)(j)) |
| Legal actions | Not before 60 days after proof of loss. Not after 3 years from when proof was required ((1)(k)). |
Other Mississippi rules
- Policies are printed in at least 10-point type (83-9-3).
- Benefits can't be limited because the insured is Medicaid-eligible. Assignments of benefits to licensed providers must be honored for 1 year (83-9-3).
- Renewability labels (Reg. LA&H 62-1): "noncancelable" requires the right to continue to at least age 50 (or 5 years if issued after 44) with no unilateral changes. "Guaranteed renewable" allows rate changes by class.
Common exam traps
- Notice of claim in Mississippi: 30 days, not 20.
- Time limit on certain defenses: 2 years.
- Grace periods: 7 / 10 / 31 days. Reinstated sickness coverage starts after 10 days.
- Clean claims: 25 / 35 days, then 3% a month.
- Suit: after 60 days and within 3 years.
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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.
