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Uniform Mandatory Provisions

The required provisions in every individual health policy: notice and proof of claim, grace periods, reinstatement, legal actions, and more. Expect number-heavy questions.

Study questions and answers

Try each question first, then tap to check your answer.

1. Notice of claim must generally be given to the insurer within how many days of a loss, or as soon as reasonably possible?

  1. 10
  2. 20
  3. 30
  4. 60
Show answer
B. 20
The notice of claim provision requires written notice within 20 days of the loss or as soon as reasonably possible.

2. After receiving notice of claim, the insurer must furnish claim forms within:

  1. 15 days
  2. 10 days
  3. 20 days
  4. 30 days
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A. 15 days
If the forms are not provided within 15 days, the claimant can submit proof of loss in their own written form.

3. Proof of loss must generally be submitted within how many days after the loss?

  1. 30
  2. 60
  3. 90
  4. 180
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C. 90
Proof is due within 90 days. If that is not reasonably possible, it can be filed later but generally no later than one year, unless the claimant lacks legal capacity.

4. Under the legal actions provision, the insured cannot sue the insurer sooner than ____ after proof of loss is filed, or later than ____ years.

  1. 30 days; 2 years
  2. 90 days; 5 years
  3. 60 days; 1 year
  4. 60 days; 3 years
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D. 60 days; 3 years
The 60-day waiting period gives the insurer time to process the claim, and the 3-year limit bars stale lawsuits.

5. What is the grace period for a health policy with monthly premiums?

  1. 7 days
  2. 31 days
  3. 10 days
  4. 30 days
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C. 10 days
Grace periods are 7 days for weekly premiums, 10 days for monthly premiums, and 31 days for all other modes.

6. If the insurer does not act on a reinstatement application within how many days, the policy is automatically reinstated?

  1. 10
  2. 31
  3. 45
  4. 60
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C. 45
If the insurer does not approve or deny the application within 45 days, the policy is reinstated automatically.

7. After reinstatement, a sickness is covered only if it begins more than ____ days after the reinstatement date.

  1. 10
  2. 15
  3. 30
  4. 45
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A. 10
Accidents are covered immediately after reinstatement. Sicknesses must begin more than 10 days later, which prevents reinstating just to cover a known illness.

8. Under the time limit on certain defenses provision, after how many years can the insurer no longer use non-fraudulent misstatements on the application to void the policy or deny a claim?

  1. 1
  2. 5
  3. 10
  4. 2
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D. 2
This is the health version of incontestability, typically two years (three in some states).

9. Under the physical examination and autopsy provision, the insurer may require an autopsy:

  1. Never
  2. Only with the family's written consent
  3. Only for AD&D claims
  4. At its own expense, where not prohibited by state law
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D. At its own expense, where not prohibited by state law
The insurer can examine the insured during a claim and request an autopsy at its own expense, unless state law prohibits it.

10. Under the entire contract provision, who can make changes to a health policy?

  1. The agent who sold it
  2. The insured, in writing
  3. An executive officer of the insurer, by endorsement
  4. The state insurance commissioner
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C. An executive officer of the insurer, by endorsement
Agents cannot change or waive policy provisions. Changes require approval by an executive officer, attached to the policy.

11. Under the time of payment of claims provision, periodic disability income benefits must be paid no less frequently than:

  1. Weekly
  2. Quarterly
  3. Monthly
  4. Annually
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C. Monthly
Other benefits are payable immediately on receipt of proof of loss.

12. Under the payment of claims provision, death benefits are paid to:

  1. The agent of record
  2. The named beneficiary, or the estate if there is none
  3. The insured's employer
  4. The state
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B. The named beneficiary, or the estate if there is none
Other benefits are paid to the insured.

13. Under the change of beneficiary provision, the policyowner may change the beneficiary:

  1. At any time, unless the beneficiary designation is irrevocable
  2. Never
  3. Only on the policy anniversary
  4. Only with the beneficiary's consent
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A. At any time, unless the beneficiary designation is irrevocable
A revocable beneficiary has no vested interest in the policy.
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