Free Individual Accident and Health Provisions Study Guide
Nevada Accident & Health exam — Individual Accident and Health Provisions.
The uniform individual accident and health policy provisions come from the NAIC model law and are explained in the national Individual Accident and Health Provisions guide. Nevada enacted them in NRS 689A, with one change that's easy to miss: Nevada's time limit on certain defenses is three years, not two. This guide lists the Nevada version of each provision.
Policy form rules
- Text must be printed in type of at least 10 points (NRS 689A.030(4)).
- A family policy may cover a child through the last day of the month the child turns 26 (NRS 689A.030(3)).
- Free look: most individual health policies may be returned within 10 days after delivery for a refund, which voids the policy from the start. Nonrenewable accident-only policies and individual credit health policies are excepted (NRS 689A.170).
- Conformity with state statutes: a provision that conflicts with Nevada law is automatically amended to meet its minimum requirements (NRS 689A.260).
- Pregnancy: treating complications of pregnancy differently from any other illness is a prohibited practice (NAC 686A.140(6)).
Required provisions
| Provision | Nevada rule |
|---|---|
| Time limit on certain defenses | After three years from issue, no misstatement except a fraudulent one can void the policy or deny a claim for a loss starting after that period (NRS 689A.060). |
| Grace period | At least 7 days for weekly-premium policies, 10 days for monthly-premium policies and 31 days for all others. If the insurer reserves the right to refuse renewal, the grace provision must say written notice of nonrenewal is given at least 30 days before the premium due date (NRS 689A.070). |
| Reinstatement | If the insurer requires an application and gives a conditional receipt, the policy is reinstated on approval or on the 45th day after the receipt unless disapproved in writing. It covers injuries after reinstatement and sickness beginning more than 10 days later (NRS 689A.080). |
| Notice of claim | Written notice within 20 days after the loss, or as soon as reasonably possible (NRS 689A.090). |
| Claim forms | Furnished within 15 days after notice. If not, the claimant can send written proof in any form (NRS 689A.100). |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible and, absent legal incapacity, within one year (NRS 689A.110). |
| Time of payment of claims | Lump-sum benefits immediately on proof. Periodic benefits at least monthly (NRS 689A.120). |
| Physical examination and autopsy | At the insurer's expense, as often as reasonably required while a claim is pending, and autopsy where the law allows (NRS 689A.140). |
| Legal actions | No suit until 60 days after proof of loss, and none after three years from when proof was required (NRS 689A.150). |
| Change of beneficiary | The insured may change the beneficiary without consent unless the designation is irrevocable (NRS 689A.160). |
Optional provisions
- Change of occupation: a move to a more hazardous job limits benefits to what the premium would buy at the higher rate (NRS 689A.200).
- Misstatement of age: benefits are adjusted to the correct age (NRS 689A.210).
- Relation of earnings to insurance: if total disability coverage exceeds the insured's earned income (the greater of current monthly earnings or the two-year average), the insurer may reduce its benefit proportionately (NRS 689A.240).
- Illegal occupation: losses to which committing a felony or working in an illegal occupation contributed may be excluded (NRS 689A.270).
Renewability
An insurer that keeps the right to refuse renewal may use it only at a renewal date on or nearest the policy anniversary, and a refusal can't affect claims that began while the policy was in force (NRS 689A.290).
Common exam traps
- Time limit on certain defenses: 3 years in Nevada.
- Grace periods: 7 weekly, 10 monthly, 31 for all others. The nonrenewal notice in the grace provision is 30 days before the due date.
- Reinstatement on the 45th day after a conditional receipt, with a 10-day wait for sickness.
- 20 / 15 / 90 days: notice, claim forms, proof of loss, with a one-year outside limit for late proof.
- Legal actions: after 60 days, within 3 years.
- Free look: 10 days, and the policy is void from the start when returned.
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.
