Free Individual Accident and Health Provisions Study Guide
Vermont Life, Accident & Health exam — Individual Accident and Health Provisions.
The national Individual Accident and Health Provisions guide covers the uniform provisions from NAIC Model 180 and what each one does. Vermont puts them in 8 V.S.A. § 4029 (required) and § 4030 (optional). Chapter 107 was renumbered effective September 1, 2025, so older materials cite different section numbers. This guide covers the Vermont wording and time periods, plus Vermont's free look.
Free look (8 V.S.A. § 4028(8))
An individual health policy must state on its face that it can be returned for a full refund:
- within 10 days after delivery, or
- within 30 days for a person eligible for Medicare because of age
Required provisions (8 V.S.A. § 4029)
| Provision | Vermont rule |
|---|---|
| Entire contract; changes (§ 4029(1)) | A change is valid only if an executive officer approves it and it is endorsed on or attached to the policy. No agent may change the policy or waive a provision. |
| Time limit on certain defenses (§ 4029(2)) | 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. |
| Grace period (§ 4029(3)) | At least 7 days for weekly premiums, 10 days for monthly, 31 days for all others. |
| Reinstatement (§ 4029(4)) | See below. |
| Notice of claim (§ 4029(5)) | Written notice within 20 days after the loss begins, or as soon as reasonably possible. |
| Claim forms (§ 4029(6)) | The insurer sends claim forms within 15 days of notice. If it doesn't, the claimant complies by sending written proof of the occurrence, character and extent of the loss. |
| Proof of loss (§ 4029(7)) | Within 90 days. Late proof is accepted if given as soon as reasonably possible and within one year, unless the claimant lacked legal capacity. |
| Time of payment (§ 4029(8)) | Paid immediately on proof. Periodic income benefits are paid at least monthly. |
| Payment of claims (§ 4029(9)) | If benefits are payable to the estate or to a minor or incompetent person, the insurer may pay up to $1,000 to a relative by blood or civil marriage it finds equitably entitled. |
| Physical exam and autopsy (§ 4029(10)) | At the insurer's expense, as often as reasonably required while a claim is pending. Autopsy only where the law allows. |
| Legal actions (§ 4029(11)) | No suit until 60 days after proof of loss and none after three years from when proof was required. |
| Change of beneficiary (§ 4029(12)) | The insured keeps the right to change the beneficiary. The beneficiary's consent isn't needed to surrender, assign or change the beneficiary. |
Reinstatement details (§ 4029(4))
- If the insurer accepts a late premium without requiring an application, the policy is reinstated.
- If the insurer requires an application and issues a conditional receipt, the policy is reinstated when the insurer approves it. If the insurer doesn't notify the insured of disapproval, it is reinstated on the 45th day after the receipt.
- The reinstated policy covers accidents after reinstatement and sickness beginning more than 10 days after it.
- A premium accepted at reinstatement can be applied to a period no more than 60 days before the reinstatement date.
Optional provisions (8 V.S.A. § 4030)
- Change of occupation: if the insured moves to a more hazardous occupation, benefits are cut to what the premium would buy at that class.
- Misstatement of age: benefits are adjusted to what the premium paid would have bought at the correct age.
Related Vermont rules
- Copy of the application: on written request, the insurer must deliver a copy within 15 days. If it doesn't, it can't use the application as evidence in a dispute over the policy (§ 4037(a)(2)).
- Coverage after a premium is accepted: coverage continues to the end of the period for which the insurer accepted premium, subject to any right to cancel (§ 4020(a)).
- Outline of coverage: it is given with the policy, or at application with a signed receipt (Reg. I-80-1 § 8(B)).
- Credit disability: the monthly benefit can't exceed the scheduled installment, and total benefits can't exceed the debt (§ 4105(b)).
- Guaranty protection: disability income up to $300,000 (§ 4173(c)).
Common exam traps
- The free look is 10 days, or 30 days for people eligible for Medicare by age.
- The grace period is 7, 10 or 31 days for weekly, monthly or other premium modes.
- Notice of claim is due in 20 days, proof of loss in 90 days, with an outside limit of one year for late proof.
- The time limit on certain defenses is three years, and fraudulent misstatements are excepted.
- Reinstatement covers sickness only after 10 days. The application is treated as approved on the 45th day without notice of disapproval.
- No suit before 60 days after proof of loss, and none after 3 years.
- A facility-of-payment amount may be paid to a relative by blood or civil marriage, up to $1,000.
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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.
