Free Individual Accident and Health Provisions Study Guide
Wisconsin 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. Wisconsin doesn't copy the model's wording. It puts its own rules in Wis. Stat. 632.72 to 632.79 and in the general insurance contract statutes (chapter 631). This guide covers the Wisconsin versions you will be tested on.
Free look (Wis. Stat. 632.73)
- An individual or franchise disability policy may be returned within 10 days after receipt. The policy is void and all payments are refunded.
- Exempt: single-premium nonrenewable policies of 6 months or less, and accident-only policies.
- Medicare supplement, Medicare replacement and long-term care policies get 30 days (632.73(2m)).
Wisconsin's provisions
| Provision | Wisconsin rule |
|---|---|
| Grace period (632.78) | At least 7 days for weekly premiums, 10 for monthly, 31 for other modes. Coverage continues during grace. |
| Reinstatement (632.74) | The insurer's acceptance is treated as being without reservation unless it sends a statement of reservations within 45 days. Losses from accidents or sickness beginning between lapse and reinstatement aren't covered. |
| Incontestability (632.76(1)) | After coverage has been in effect 2 years, non-fraudulent application misstatements can't be used to void the policy or deny a claim. |
| Preexisting conditions (632.76(2)(ac)) | An individual policy may look back no more than 12 months before coverage. |
| Change of occupation (632.77(1)) | A move to a less hazardous job requires a retroactive premium reduction. A move to a more hazardous job may reduce benefits proportionally. |
| Misstatement of age (632.77(2)) | Limited to reducing the benefit to what the premium would have bought at the correct age. |
| Notice of claim and proof of loss (631.81) | Late notice or proof still counts if given as soon as reasonably possible and within one year, unless the insurer was prejudiced. Mailing first-class within the deadline counts as timely. |
| Claim payment (628.46) | A claim is overdue if not paid within 30 days after written notice of the loss and amount. Overdue amounts earn 7.5% simple interest. |
| Change of beneficiary (632.48) | The owner may change a beneficiary who isn't irrevocable without consent. |
Cancellation
For policies subject to Wis. Stat. 631.36, an insurer's midterm cancellation takes effect at least 10 days after written notice is mailed or delivered.
Sales rules for individual health policies
- Suitability: an agent may recommend a policy only after a reasonable inquiry gives grounds to believe it isn't unsuitable (Ins 3.27(7)).
- An outline of coverage is given when the application is taken (Ins 3.27(8)(b)).
- Replacement (Ins 3.29): the application asks about replacement, and the applicant signs a replacement notice. The notice warns about:
- new preexisting-condition limits and waiting periods
- answering health questions truthfully
- issue at an older age
- differences in renewal terms
- Advertising must fairly present benefits and limitations (Ins 3.27).
Common exam traps
- The individual health free look is 10 days. Accident-only policies are exempt. Medigap and LTC get 30 days.
- Grace periods are 7/10/31 days.
- Incontestability is 2 years, and fraud is excepted.
- The preexisting-condition look-back for individual policies is 12 months.
- A move to a safer job means a premium refund, not just a benefit change.
- Claims are overdue after 30 days and earn 7.5% interest.
- Late notice or proof is accepted up to one year if reasonable and the insurer wasn't prejudiced.
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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.
