Free Individual Accident and Health Provisions Study Guide
South Dakota Accident & Health exam — Individual Accident and Health Provisions.
South Dakota writes the uniform individual health policy provisions into statute at SDCL 58-17-14 to 58-17-39. The national guide explains NAIC Model 180's required and optional provisions. This guide gives South Dakota's versions and time limits, which are the numbers the state questions use.
Free look
- An individual health policy may be returned within 10 days of delivery for a full premium refund (SDCL 58-17-11). Single-premium nonrenewable policies are excepted.
- A returned policy is void from the beginning.
Required provisions
| Provision | South Dakota rule |
|---|---|
| Entire contract; changes (58-17-14) | The policy, endorsements and attached papers are the entire contract. A change is valid only if an executive officer approves it and it's endorsed or attached. No producer can change the policy or waive a provision. A rider or application that reduces or eliminates coverage needs the policyholder's signed acceptance. |
| Time limit on certain defenses (58-17-15) | After 2 years from the date of issue, misstatements other than fraudulent ones can't be used to void the policy or deny a claim for a loss that starts after that period. |
| Grace period (58-17-17) | At least 7 days for weekly premiums, 10 days for monthly, 31 days for all other modes. |
| Renewal notice (58-17-18) | If the insurer reserves the right not to renew, it must give notice at least 30 days before the premium due date. |
| Reinstatement (58-17-19) | Acceptance of a late premium reinstates the policy. If a conditional receipt is issued, the policy is reinstated on approval or on the 45th day unless the insurer disapproves. After reinstatement, accidents are covered right away. Sickness is covered only if it begins more than 10 days after reinstatement. |
| Notice of claim (58-17-21) | Written notice within 20 days after the loss, or as soon as reasonably possible. |
| Claim forms (58-17-23) | If the insurer doesn't send forms within 15 days of notice, the claimant can submit proof in their own words. |
| Proof of loss (58-17-24) | Within 90 days after the loss. Late proof is accepted if it wasn't reasonably possible sooner, but generally no later than 1 year after it was due, unless the claimant lacked legal capacity. |
| Time of payment (58-17-25) | Non-periodic benefits are paid immediately on proof. Periodic benefits are paid at least monthly. |
| Payment of claims (58-17-26) | Death benefits go to the named beneficiary or, if none, the insured's estate. All other benefits go to the insured. |
| Physical exam and autopsy (58-17-28) | At the insurer's expense, as often as reasonably needed while a claim is pending. An autopsy is allowed where the law doesn't forbid it. |
| Legal actions (58-17-29) | No suit until 60 days after proof of loss. No suit after 3 years from the date proof was required. |
Optional provisions
| Provision | South Dakota rule |
|---|---|
| Change of occupation (58-17-32) | If the insured moves to a more hazardous job, benefits are reduced to what the premium would buy at the riskier rate. A less hazardous job lowers the premium. |
| Misstatement of age (58-17-33) | Benefits are adjusted to what the premium would have bought at the correct age. |
| Unpaid premium (58-17-37) | Premium that's due and unpaid may be deducted from a claim payment. |
| Conformity with state statutes (58-17-38) | Terms that conflict with the law of the insured's state of residence are amended to meet its minimums. |
| Illegal occupation (58-17-39) | Excludes a loss caused in part by the insured committing or attempting a felony, or working in an illegal occupation. |
Related South Dakota rules
- When a producer sells the policy, the outline of coverage is delivered at application (58-33A-5).
- Application statements are representations, not warranties. A misstatement defeats recovery only if it's fraudulent, material to the risk, or would have changed the insurer's decision (58-11-44).
- The insurer must send a copy of the application within 30 days of a written demand, or the application can't be used as evidence (58-11-43).
Common exam traps
- Grace periods depend on the premium mode: 7 / 10 / 31 days.
- Notice of claim: 20 days. Claim forms: 15 days. Proof of loss: 90 days, with a 1-year outer limit.
- Suits: not before 60 days after proof and not after 3 years.
- After reinstatement, sickness is covered only if it starts more than 10 days later.
- The time limit on defenses is 2 years, and fraudulent misstatements are excepted.
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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.
