Accident and health insurance policy provisions

What this document is

S.C. Code Ann. ch. 38-71: Accident and health insurance policy provisions is a state statute published by South Carolina Legislature (scstatehouse.gov). It is one of the South Carolina documents that insurance license exam questions are written from, including south carolina 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.

• S.C. Code Ann. § 38-71-40 (Effect of False Statement in Application)

  “The falsity of any statement in the application for any policy covered by this chapter does not bar the right to recovery thereunder unless the false statement was made with actual intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the insurer.”

• S.C. Code Ann. § 38-71-60 (Certain Acts Do Not Constitute a Waiver by Insurer)

  “The acknowledgment of any insurer of the receipt of notice given under any policy covered by this chapter, the furnishing of forms for filing proofs of loss, the acceptance of proofs of loss, or the investigation of any claim thereunder does not operate as a waiver of any of the rights of the...”

• S.C. Code Ann. § 38-71-110 (Notice of Failure of Employer to Remit Deducted Premium Required Before Forfeiture)

  “declare forfeited or lapsed the policy until and unless a written or printed notice of the failure of the employer to remit the premium or installment thereof, stating the amount or portion thereof due on the policy and to whom it must be paid, has been duly addressed and mailed to the person who...”

• S.C. Code Ann. § 38-71-242 (Specified disease insurance policies; payment of claims and benefits)

  “an insurer or issuer of any individual or group specified disease insurance policy shall not pay any claim or benefits based upon an actual charge, actual charges, actual fee, or actual fees under the applicable policy in an amount in excess of the "actual charge", "actual charges", "actual fee",...”

• S.C. Code Ann. § 38-71-230 (Written notice of health insurance claim policies and procedures)

  “All licensed health care providers are required to provide written notice of the policies and procedures with regard to health insurance claims. The notice may take the form of a patient information card or notice clearly posted in all patient waiting areas of the providers' place of business.”

• S.C. Code Ann. § 38-71-80 (Construction of Policy Issued in Violation of Chapter)

  “A policy issued in violation of this chapter is held valid but must be construed as provided in this chapter, and, when any provision in the policy is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the policyholder, and the beneficiary are...”

• S.C. Code Ann. § 38-71-170 (Conversion privileges for former spouses)

  “Every policy which contains a provision for termination of coverage of the spouse upon divorce shall contain a provision to the effect that upon the entry of a valid decree of divorce between the insured parties the divorced spouse is entitled to have issued to him or her, without evidence of...”

• S.C. Code Ann. § 38-71-210 (Optional chiropractic rider in health insurance policies)

  “If an insurer offers a policy containing a provision for medical expense benefits that does not provide payment for chiropractic services, it shall offer as a part thereof an optional rider or endorsement, if specifically requested by the insured or subscriber under an individual policy or a...”

• S.C. Code Ann. § 38-71-110 (Notice of employer's failure to remit deducted premium required before forfeiture)

  “No insurer doing business in this State and issuing health or accident insurance policies, other than contracts of group insurance of disability, accidental death, or disability and accidental death benefits in connection with policies of life insurance, the premium for which is to be collected in...”

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More South Carolina sources

• S.C. Code Ann. ch. 38-57: Unfair trade practices in the business of insuranceState statute
• S.C. Code Ann. ch. 38-43: Producers (licensing, appointment, discipline)State statute
• S.C. Code Ann. ch. 38-63: Life insurance policy provisionsState statute
• South Carolina Code of Laws Title 38, Chapters 5, 43 and part of 55 (first third)State statute
• South Carolina Code of Laws Title 38, Chapters 55, 57, 59, 63 and part of 65 (second third)State statute
• South Carolina Code of Laws Title 38, Chapters 65, 71 and 72 (final third)State statute
• South Carolina Insurance Content OutlinesCandidate handbook or exam outline
• South Carolina Insurance Licensing Candidate HandbookCandidate handbook or exam outline