Model Regulation to Implement the Accident and Sickness Insurance Minimum Standards Model Act

What this document is

Model Regulation to Implement the Accident and Sickness Insurance Minimum Standards Model Act is a naic model law published by National Association of Insurance Commissioners (NAIC). It is one of the documents that insurance license exam questions are written from, including life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• NAIC Model #171: Section 7G(3) (Disability Income Protection Coverage: benefit period)

  “No reduction in benefits shall be put into effect because of an increase in Social Security or similar benefits during a benefit period.”

• NAIC Model #171: Section 7 (Definitions: Disability Income Protection Coverage)

  “is a policy that provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from either sickness or injury or a combination of them that:”

• NAIC Model #171: Minimum Standards (definition of total disability)

  “the complete inability of the person to perform all of the substantial and material duties of his or her regular occupation or words of similar import.”

• NAIC Model #171: Minimum Standards (residual / proportionate disability)

  “A policy that provides for residual disability benefits may require a qualification period, during which the insured must be continuously totally disabled before residual disability benefits are payable. The qualification period for residual benefits may be longer than the elimination period for total disability.”

• NAIC Model #171: Section 5 (Policy Definitions)

  “Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care or treatment within a [two] year period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended...”

• NAIC Model #171: Section 7 (Minimum Standards for Benefits)

  “A “noncancellable,” “guaranteed renewable,” or “noncancellable and guaranteed renewable” individual accident and sickness policy shall not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than...”

• NAIC Model #171: Section 6 (Prohibited Policy Provisions)

  “Where waivers are required as a condition of issuance, renewal or reinstatement, signed acceptance by the insured is required unless on initial issuance the full text of the waiver is contained either on the first page or specification page.”

• NAIC Model NAIC 171: Section 7I (Specified Disease Coverage)

  “(1) “Specified disease coverage” pays benefits for the diagnosis and treatment of a specifically named disease or diseases. A specified disease policy must meet the following rules and one of the following sets of minimum standards for benefits:”

• NAIC Model NAIC 171: Section 8A (Required Disclosure Provisions)

  “(22) All dental plan policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of...”

• NAIC Model NAIC 171: Section 7D (Hospital Confinement Indemnity Coverage)

  “Except for the NAIC uniform provision regarding other insurance with the insurer, benefits shall be paid regardless of other coverage.”

• NAIC Model NAIC 171: Section 7J (Specified Accident Coverage)

  “is a policy that provides coverage for a specifically identified kind of accident (or accidents) for each person insured under the policy for accidental death or accidental death and dismemberment combined, with a benefit amount not less than [$1,000] for accidental death, [$1,000] for double...”

• NAIC Model NAIC 171: Section 7B (Basic Hospital Expense Coverage)

  “provides coverage for a period of not less than thirty-one (31) days during a continuous hospital confinement for each person insured under the policy, for expense incurred for necessary treatment and services rendered as a result of accident or sickness for at least the following:”

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Questions about this source

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