Free Individual Accident and Health Provisions Study Guide
Ohio Accident & Health exam — Individual Accident and Health Provisions.
The uniform individual accident and health policy provisions come from the NAIC model law and are explained in the national Individual Accident and Health Provisions guide. Ohio's versions are in R.C. 3923.04 (required) and 3923.05 (optional), with a 10-day free look in 3923.31. One Ohio provision stands out: the insured may cancel, but the insurer may not.
Free look (R.C. 3923.31)
- The policyholder may rescind until at least midnight of the tenth day after receiving the policy, without giving a reason.
- The insurer may keep a per diem pro rata charge for coverage in force before the return.
- The notice is printed prominently on the first page or attached, saying how and where to return the policy.
- Single-premium nonrenewable policies are excluded.
Required provisions (R.C. 3923.04)
| Provision | Ohio rule |
|---|---|
| Entire contract | The policy and attached papers are the entire contract. |
| Time limit on certain defenses | After two years from issue, no non-fraudulent misstatement can void the policy or deny a claim. |
| Grace period | At least 7 days for weekly premiums, 10 days for monthly and 31 days for all others. If the insurer may refuse renewal, it must give written notice at least 5 days before the due date. |
| Reinstatement | Reinstated on approval or on the 45th day after the conditional receipt, unless the insured is told of disapproval first. |
| Notice of claim | Within 20 days after the loss, or as soon as reasonably possible. A disability policy may require notice of continued disability at least once every six months (3923.04(E)). |
| Claim forms | If not furnished in time, written proof covering the occurrence, character and extent of the loss is enough. |
| Proof of loss | Late proof is accepted if given as soon as reasonably possible, but no later than one year after it was due, absent legal incapacity. |
| Time of payment of claims | Immediately on, or within 30 days after, receipt of proof. |
| Payment of claims | Benefits go to the estate if no beneficiary is named. A facility-of-payment amount may not exceed $1,000. |
| Legal actions | No suit until 60 days after proof of loss, and none after three years from when proof was required. |
| Cancellation | "Cancellation by the insured. Non-cancellation by the insurer." The insured may cancel at any time by written notice, effective on receipt or a later date. Earned premium is figured on the short-rate table. The insurer may not cancel (3923.04(M)). |
Optional provisions (R.C. 3923.05)
- Change of occupation: benefits for a more hazardous job are limited to what the premium would buy at that rate (3923.05(A)).
- Misstatement of age: benefits are adjusted to the correct age (3923.05(B)).
- Relation of earnings to insurance: compares disability benefits with the greater of monthly earnings when disability began or the average for the prior two years (3923.05(F)).
- Illegal occupation: losses to which a felony or illegal occupation contributed may be excluded (3923.05(I)).
Common exam traps
- Insured can cancel; insurer can't. This replaces the model's optional insurer cancellation clause.
- Free look: 10 days, with a possible pro rata charge for coverage in force.
- Grace periods: 7 / 10 / 31 days. Nonrenewal notice in the grace clause is 5 days.
- Claims paid within 30 days of proof.
- Facility of payment limited 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.
