Free Individual Accident and Health Provisions Study Guide
Rhode Island Life, Accident & Health exam — Individual Accident and Health Provisions.
Rhode Island's uniform individual accident and sickness provisions are in R.I. Gen. Laws 27-18-3 (required) and 27-18-4 (optional). Two state differences stand out:
- The time limit on certain defenses is 3 years.
- The intoxicants and narcotics provision can't be used in a medical expense policy.
Rhode Island also requires a minimum home health care benefit. What each provision means in general is in the national Individual Accident and Health Provisions guide.
Required provisions (27-18-3(a))
| Provision | Rhode Island rule |
|---|---|
| Entire contract; changes | Changes are valid only when approved by an executive officer and endorsed on or attached to the policy |
| Time limit on certain defenses | 3 years from issue |
| Grace period | 7 days weekly, 10 days monthly, 31 days for other modes (such as quarterly). If the insurer reserves the right to refuse renewal, nonrenewal notice must be given at least 10 days before the premium due date. |
| Reinstatement | Automatic on the 45th day after a conditional receipt. Premium can't be applied more than 60 days before reinstatement. Sickness coverage starts after a 10-day wait. |
| Notice of claim | Within 20 days after the loss, or as soon as reasonably possible. For disability benefits of 2 years or more, continuance notice may be required every 6 months. |
| Claim forms | If not furnished within 15 days, the claimant may submit proof in their own written statement |
| Proof of loss | Within 90 days. Late proof is accepted if reasonable, but no later than 1 year after it was due, absent legal incapacity. |
| Time of payment of claims | Promptly on proof. Periodic benefits, such as disability income, are paid at least monthly. |
| Payment of claims | To the insured, or a named beneficiary for death benefits. Optional facility of payment up to $1,000 to a relative. |
| Physical exam and autopsy | During a pending claim, at the insurer's expense |
| Legal actions | Suit allowed only after a waiting period following proof of loss. None after 3 years from when proof is required. |
| Change of beneficiary | The beneficiary's consent isn't needed unless the designation is irrevocable |
Optional provisions (27-18-4)
- Change of occupation: benefits or rates are adjusted for a more or less hazardous job.
- Misstatement of age: benefits are what the premium would buy at the correct age.
- Relation of earnings to insurance: benefits are reduced when total disability income exceeds earnings.
- Conformity with state statutes: conflicting terms are automatically amended to meet the law.
- Cancellation: Rhode Island's law still lists this provision (27-18-4(8)).
- The insurer's notice must give an effective date at least 10 days after notice.
- Unearned premium is returned promptly.
- Illegal occupation: no liability for a loss to which the insured's commission of a felony, or an illegal occupation, contributed (27-18-4(10)).
- Intoxicants and narcotics: allowed only in policies that are not medical expense policies (27-18-4(11)).
Rhode Island additions
Home health care (27-18-3(c))
- Accident and sickness policies, other than disability income and limited benefit policies, must include a minimum home health care benefit.
- That benefit excludes communicable disease and nervous, emotional and mental illness.
HIV (23-6.3-16)
- A policy can't be canceled or nonrenewed because of a positive HIV test.
Disability settlements (230-RICR-20-40-1.4(K))
- When an insurer offers a cash settlement of an undisputed long-term disability income claim, the insured receives a signed present value calculation of future benefits.
Claims handling (230-RICR-20-40-1)
- Claim forms and help within 15 days.
- Written denials cite the provision relied on, within 15 days of the decision.
- Payment within 30 days once liability is affirmed.
- Tell an objecting claimant that the Insurance Division may review the matter.
Guaranty protection (27-34.3-3)
- The Rhode Island Life and Health Insurance Guaranty Association covers disability income up to $300,000 and other health coverage up to $100,000.
Common exam traps
- Time limit on certain defenses: 3 years in Rhode Island.
- Grace: 7 / 10 / 31 days by premium mode. Nonrenewal notice at least 10 days before the due date.
- Intoxicants and narcotics can't be used in a medical expense policy.
- Insurer cancellation: effective no sooner than 10 days after notice.
- Legal actions: no suit after 3 years from when proof was required.
Practice Individual Accident and Health Provisions questions All Life, 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.
