Free Individual Accident and Health Provisions Study Guide
Utah Life, Accident & Health exam — Individual Accident and Health Provisions.
Utah writes its own A&H policy provisions into Utah Code 31A-22-605 to 31A-22-614, with general claim rules in 31A-21-312 and 31A-21-313 and minimum standards in R590-126. Several Utah numbers differ from NAIC Model 180, which the national guide covers. The grace period is 15 days and proof of loss is 180 days. Learn the Utah versions.
Free look (31A-22-606)
- An individual A&H policy may be returned for any reason within 10 days after delivery. It's then void from the beginning and premium is refunded.
- Exceptions: group policies, short single-premium nonrenewable policies and accident-only policies.
- A limited A&H policy issued to a Medicare-eligible person gets 30 days (31A-22-605).
Policy provisions
| Provision | Utah rule |
|---|---|
| Grace period (31A-22-607) | At least 15 days for weekly or monthly premiums, and 30 days for other modes. Utah treats an individual policy as not in force during the grace period. If the premium arrives in time, coverage continues with no gap. If it doesn't, the policy ends as of the last paid date. Group policies: 30 days, in force during the grace period. |
| Reinstatement (31A-22-608) | On approval, or on the 45th day after a conditional receipt. Accidents are covered right away. Sickness is covered only if it begins more than 10 days later. Premium can't be applied more than 60 days before reinstatement. |
| Time limit on defenses (31A-22-609) | After 2 years, statements about insurability can't void coverage or deny claims, except fraudulent ones. The insurer must prove fraud by clear and convincing evidence. Preexisting conditions can then be denied only if excluded by name or specific description. |
| Notice of claim (31A-22-614) | No stricter than written notice within 20 days of the loss. |
| Proof of loss (31A-22-614) | The insured gets at least 180 days after the loss. Late notice or proof is still valid if filing on time wasn't reasonably possible and it was filed as soon as it was (31A-21-312). |
| Claim forms (31A-21-312) | If forms aren't provided, a written statement of the loss serves as proof. |
| Payment of claims (31A-22-614) | Death benefits follow the beneficiary designation, or go to the estate. Medical benefits may be paid directly to the provider at the insurer's option. |
| Legal actions (31A-21-313) | No suit until 60 days after proof of loss, or until an earlier denial or waiver. Suit must be filed within 3 years after the loss began. |
| Change of occupation; misstatement of age (31A-22-613) | A riskier job reduces benefits. A safer job requires a retroactive premium reduction. A misstated age adjusts benefits to what the premium would buy. |
Minimum standards (R590-126)
Renewability
- Noncancellable: renewable to at least 65, with no rate changes.
- Guaranteed renewable: renewable to at least 65, but rates can change by class.
- Nonrenewal notice: 90 days. Premium change notice: 45 days.
- A policy can't be nonrenewed solely because the insured's health has declined.
Probationary periods
- Up to 6 months for listed conditions, such as hernia or tonsils.
- Up to 30 days for specified disease policies.
- None for accident policies.
Preexisting conditions (31A-22-605.1)
- Specified disease policies: no exclusion for losses more than 6 months after the effective date.
- Policies with no health questions: no exclusion for losses more than 12 months after the effective date.
Other standards
- A recurrent disability provision can't require more than 6 months between disabilities.
- AD&D must pay for losses within 180 days of the accident.
- Specified disease policies require a buyer's guide at application.
- An outline of coverage comes with the policy or at application (31A-22-605).
- A replacement notice is given before the new policy is issued or delivered (R590-126-9).
Common exam traps
- Utah's grace period is 15 days for weekly or monthly premiums, not 7 or 10.
- Proof of loss: at least 180 days, not 90.
- Suits: wait 60 days, and file within 3 years of the loss.
- Fraud after 2 years must be proven by clear and convincing evidence.
- Nonrenewal notice: 90 days. Premium change notice: 45 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.
