Free Individual Accident and Health Provisions Study Guide
New Hampshire Accident & Health exam — Individual Accident and Health Provisions.
The uniform individual policy provisions are covered in the national Individual Accident and Health Provisions guide, based on NAIC Model 180. New Hampshire's version is RSA 415:6. It adds required provisions the model doesn't have, on pre-certification, refunds and Social Security offsets. It also changes two familiar ones: reinstatement has no 10-day sickness wait, and other insurance in this insurer isn't prorated.
Required provisions (RSA 415:6, I)
| Provision | New Hampshire rule |
|---|---|
| Entire contract; changes | A change is valid only if an executive officer approves it by endorsement. No agent may change or waive a provision |
| Time limit on certain defenses | After two years from issue, non-fraudulent misstatements can't void the policy or deny a claim for a loss that starts after that |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for all others. If the insurer reserves the right to refuse renewal, the grace period can exclude a premium due after written notice of nonrenewal given at least 5 days before the due date |
| Reinstatement | Accepting a late premium without requiring an application reinstates the policy. If an application and conditional receipt are used, the policy is reinstated on approval or on the 45th day. It covers accidents and sickness beginning on or after the reinstatement date, with no extra 10-day sickness waiting period. Premium can't apply to periods more than 60 days back |
| Notice of claim | Within 20 days after the loss begins, or as soon as reasonably possible. Disability policies may require notice of continuing disability at least every six months |
| Claim forms | Furnished within 15 days. If not, written proof in any form complies |
| Proof of loss | Within 90 days after the loss, or one year for Medicare supplement policies. Late proof is accepted if given as soon as reasonably possible, but no later than one year after it was due, unless the claimant lacked legal capacity |
| Time of payment | Non-periodic benefits are paid immediately on proof. Periodic benefits are paid at least monthly |
| Payment of claims | A facility-of-payment clause may pay a relative up to $1,000 |
| Physical exam and autopsy | At the insurer's expense while a claim is pending. Autopsy where not forbidden by law |
| Legal actions | No suit until 60 days after proof of loss, and none after three years from when proof was required |
| Change of beneficiary | No beneficiary consent needed unless the designation is irrevocable |
| Social Security offsets | If benefits are reduced by Social Security, later Social Security increases can't reduce them further |
| Refund on cancellation | Unearned premium is refunded pro rata within 30 days |
| Pre-certification | When two plans cover the insured, pre-certification comes from the primary plan. The secondary plan can't refuse payment solely because it didn't pre-certify |
Optional provisions (RSA 415:6, II)
- Change of occupation. A riskier job limits benefits to what the premium buys at the higher rate. A safer job lowers the premium.
- Misstatement of age. Benefits become what the premium would have bought at the correct age.
- Other insurance in this insurer. Payment is not prorated or reduced. The insured may collect from both insurers. The exception is a benefits deductible on an approved major medical policy.
- Relation of earnings to insurance. Total monthly benefits are never cut below $200, or the total benefits, whichever is less.
- Unpaid premium. Premium due may be deducted from a claim.
- Cancellation or nonrenewal. Where the policy allows it, the insurer must act on every policyholder in the class and get the Commissioner's prior written approval.
- Conformity with state statutes. Conflicting provisions are amended to meet the law of the insured's state.
Other individual policy rules
- Misstatements on the application (415:9). A false statement bars recovery only if made with actual intent to deceive, or if it materially affected acceptance of the risk or the hazard assumed.
- Age limits (415:13). If premium is accepted past a policy age limit, coverage continues through the period paid for.
- Outline of coverage (RSA 415-A:4):
- It's delivered when the application is made, with an acknowledgment of receipt sent to the insurer.
- Or it accompanies the policy and states that it isn't the policy applied for.
- Prompt payment. Clean claims are paid in 15 days if electronic or 30 days if paper, with 1.5% a month interest when late (415:6-h).
Common exam traps
- New Hampshire reinstatement covers sickness from the reinstatement date, with no 10-day waiting period.
- Proof of loss is 90 days, but one year for Medicare supplement.
- Other insurance with the same insurer is not prorated.
- The facility-of-payment cap is $1,000, and the relation of earnings floor is $200.
- Unearned premium is refunded pro rata within 30 days.
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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.
