Free Individual Accident and Health Provisions Study Guide
Idaho Life, Accident & Health exam — Individual Accident and Health Provisions.
Idaho writes the uniform individual health ("disability") policy provisions into Idaho Code 41-2105 to 41-2140. The national guide explains what each provision does. These notes give Idaho's wording and numbers.
Required provisions
| Provision | Idaho rule |
|---|---|
| Entire contract | The policy, endorsements and attached papers are the entire contract. Changes need an executive officer's approval and must be endorsed or attached. No agent may change the policy or waive its terms (Idaho Code 41-2105) |
| Time limit on certain defenses | After two years from issue, only fraudulent misstatements can void the policy. A claim can't be denied because of a condition that existed before coverage unless it is excluded by name. With a simplified application that asks no health questions, preexisting conditions not specifically excluded are covered after 12 months (Idaho Code 41-2106) |
| Grace period | 7 days for weekly premiums, 10 days for monthly, 31 days for all others. An insurer that reserves the right to refuse renewal must give written nonrenewal notice at least 30 days before the premium due date (Idaho Code 41-2107) |
| Reinstatement | Automatic on the 45th day after a conditional receipt, unless the insurer disapproves. Accidents are covered after reinstatement; sickness only if it begins more than 10 days later (Idaho Code 41-2108) |
| Notice of claim | Within 20 days, or as soon as reasonably possible (Idaho Code 41-2109) |
| Claim forms | Furnished within 15 days. Otherwise, written proof of loss in any form counts (Idaho Code 41-2110) |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible, but no later than one year after it was due, unless the claimant lacked legal capacity (Idaho Code 41-2111) |
| Time of payment of claims | Lump sums are paid immediately on proof. Periodic benefits are paid at least monthly (Idaho Code 41-2112) |
| Payment of claims | Death benefits go to the beneficiary, or to the estate if none is named. The optional facility-of-payment clause allows up to $1,000 to a relative (Idaho Code 41-2113) |
| Physical examination and autopsy | At the insurer's expense, as often as reasonably required while a claim is pending. Autopsy where the law allows (Idaho Code 41-2114) |
| Legal actions | No suit until 60 days after proof of loss, and none more than three years after proof was due (Idaho Code 41-2115) |
| Change of beneficiary | Belongs to the insured unless the designation is irrevocable. No beneficiary consent is needed (Idaho Code 41-2116) |
Optional provisions
- Change of occupation (Idaho Code 41-2118):
- More hazardous job: benefits drop to what the premium buys at the riskier rate.
- Less hazardous job: the premium is reduced and the excess is refunded.
- Misstatement of age: benefits are adjusted to what the premium would buy at the correct age (Idaho Code 41-2119).
- Relation of earnings to insurance: benefits may be prorated, but total monthly benefits may not fall below the lesser of $200 or the sum of the benefits (Idaho Code 41-2123).
- Unpaid premium: an unpaid premium may be deducted from a claim payment (Idaho Code 41-2124).
- Illegal occupation: losses contributed to by committing a felony or working in an illegal occupation may be excluded (Idaho Code 41-2126).
- Intoxicants and narcotics: losses while intoxicated, or under a narcotic not taken on a doctor's advice, may be excluded (Idaho Code 41-2127).
Renewal, free look and refunds
- Nonrenewal: an individual policy may be nonrenewed only on the renewal date nearest an anniversary, and without prejudice to claims that began while it was in force (Idaho Code 41-2128).
- Third-party ownership: someone with an insurable interest may own a policy on the insured (Idaho Code 41-2130).
- Free look: 10 days after delivery. A returned policy is void from the beginning (Idaho Code 41-2138).
- Refunds:
- At death, unearned premium is refunded pro rata from the month after death (Idaho Code 41-1332).
- On cancellation, unused premium is refunded pro rata (Idaho Code 41-1333).
- Probationary periods are generally prohibited except as the minimum-standards rule allows (IDAPA 18.04.08.020).
- Disabled dependents stay covered with proof within 31 days of the limiting age (Idaho Code 41-2139).
Common exam traps
- Idaho's time limit on certain defenses is two years.
- Proof of loss has an outer limit of one year. Facility of payment is capped at $1,000.
- The health free look is 10 days, while life and annuities get 20 days.
- Only an executive officer can change the contract.
- Idaho allows optional illegal-occupation and intoxicants exclusions.
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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.
