Uniform Individual Accident and Sickness Policy Provisions Act
What Is a Uniform Individual Accident and Sickness Policy Provisions Act?
A Uniform Individual Accident and Sickness Policy Provisions Act is legislation that each U.S. state has passed into law in some form. It specifies that individual health care coverage policies must contain certain provisions to be legitimate.
Understanding the Uniform Individual Accident and Sickness Policy Provisions Act
The legislation was made to lay out a standard of quality and to guarantee health care coverage policies have an adequate level of coverage by expecting that certain provisions be written into each policy. It was written by the National Association of Insurance Commissioners (NAIC), a non-legislative organization that is contained the insurance commissioners of each and every state and region. The NAIC isn't itself a regulator. Insurance markets are regulated at the state level.
Mandatory Uniform Policy Provisions
The 12 mandatory provisions incorporate the rights and obligations of both the insurer and the insured. Among the burdens that fall on the insurer are the need to incorporate any significant information inside the original policy or official amendments, the requirement of a stated grace period for delinquent premium payments, and guidelines for reinstatement of a that policyholder grace period. The provisions that cover the obligations of the policyholder incorporate requirements that they tell the insurer of a claim in something like 20 days of a loss, give proof of the degree of that loss, and update beneficiary information when changes happen.
Discretionary Uniform Policy Provisions
After the 12 mandatory provisions, insurers might remember any of 11 discretionary conditions for a policy. The policyholder and the insurer can arrange which of these provisions will be part of the policy, yet generally, the insurer will have the last say. The 11 discretionary provisions will generally place to a greater degree a burden on the insured to consent to certain requirements than on the insurer. These requirements incorporate the obligation to inform the insurer of changes in income, particularly if due to a disability, or changes to a pretty much risky occupation. The discretionary conditions likewise state that any misstatements in regards to age, utilization of unlawful substances, or engagement in unlawful occupations will unfavorably affect the insured's ability to collect on claims generally covered by a policy.
Features
- Uniform Policy Provisions are a set of mandatory and discretionary conditions remembered for health care coverage policies.
- Each state has made its adaptation of law that gives uniform individual accident and sickness law, itemizing what provisions are required and which are discretionary.
- There are 12 mandatory and 11 discretionary conditions for use by insurance companies.
