Free Individual Accident and Health Provisions Study Guide
Montana Life, Accident & Health exam — Individual Accident and Health Provisions.
The uniform individual policy provisions and how they work are covered in the national Individual Accident and Health Provisions guide, based on NAIC Model 180. Montana enacts its own version in Mont. Code Ann. 33-22-201 to 33-22-229. A 2025 amendment moved Montana away from the model on notice of claim, so don't answer Montana questions with the national figures.
Required provisions: Montana's figures
| Provision | Montana rule |
|---|---|
| Entire contract; changes (33-22-204) | The policy plus attached papers is the entire contract. A change needs an executive officer's approval endorsed on or attached to the policy. No producer may change the policy or waive a provision |
| Time limit on certain defenses (33-22-205) | After 2 years from issue, only fraudulent misstatements can void the policy or deny a claim for a loss starting after that period |
| Grace period (33-22-206) | 7 days for weekly-premium policies, 10 days for monthly, 31 days for all others |
| Reinstatement (33-22-207) | If the insurer issues a conditional receipt and doesn't disapprove in writing, the policy is reinstated on the 45th day. It covers accidents after reinstatement and sickness beginning more than 10 days after |
| Notice of claim (33-22-208) | Written notice within 6 months after the loss, or as soon as reasonably possible. Notice to any authorized producer counts as notice to the insurer |
| Claim forms (33-22-209) | Furnished within 15 days after notice. If not, the claimant may send proof of loss in any written form |
| Proof of loss (33-22-210) | Within 90 days after the loss. Late proof is accepted if given as soon as reasonably possible, but no later than 1 year (unless the claimant lacks legal capacity) |
| Time of payment (33-22-211) | Benefits are paid on receipt of proof. Periodic benefits are paid at least monthly. The 30-day pay-or-deny rule in 33-18-232 also applies |
| Payment of claims (33-22-212) | Death benefits go to the beneficiary, or to the estate if none. A facility-of-payment clause may pay a relative up to $1,000 |
| Legal actions (33-22-214) | No suit until 60 days after proof of loss, and none after 3 years from when proof was required |
| Change of beneficiary (33-22-215) | Reserved to the insured. No beneficiary consent needed unless the designation is irrevocable |
Optional provisions include relation of earnings to insurance (33-22-227), which limits disability benefits to earnings, and unpaid premium (33-22-228), which deducts unpaid premium from a claim. A provision that conflicts with Montana law is automatically amended to conform (33-22-229).
Form and delivery
- The policy text must be printed in at least 10-point type (33-22-201).
- A commissioner-approved outline of coverage must be given at the time of application (33-22-244).
Children and family members
- Newborns (33-22-301):
- Covered from the moment of birth, with no waiting or elimination period.
- To keep coverage past 31 days, the policy may require notice of birth and any added premium within 31 days.
- Adopted children are covered from the date of placement, with no preexisting condition exclusion (33-22-130).
- Disabled dependents. A child who can't support themselves because of an intellectual or physical disability, and who is chiefly dependent on the insured, stays covered past the limiting age (33-22-304).
- Continuity of coverage. Family members on an individual family policy keep coverage on the named insured's death or on divorce, annulment or legal separation (33-22-306).
Claims, renewals and rescission
- Postclaim underwriting is prohibited. After issue, an insurer may rescind or add an elimination rider only for a material misrepresentation or fraudulent misstatement, or for nonpayment (33-18-215).
- Cancellation. For nonpayment: at least 30 days' notice. For any reason other than nonpayment or material misrepresentation: 90 days' notice (33-22-121).
- Prompt payment. Pay or deny within 30 days of proof of loss, or 60 days if more information was reasonably requested. Late payments carry 10% interest (33-18-232).
Common exam traps
- Montana's notice of claim period is 6 months, not the NAIC model's 20 days.
- Time limit on certain defenses: 2 years.
- Grace periods: 7 days weekly, 10 days monthly, 31 days otherwise.
- Claim forms: 15 days. Proof of loss: 90 days, with an outer limit of 1 year.
- Legal actions: wait 60 days, and sue within 3 years.
- A producer can't waive or change any provision.
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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.
