A&H Policy ProvisionsQuestion 343 of 716

Under the Uniform Provisions Law, the 'time limit on certain defenses' (incontestability) provision in an individual health policy generally prevents the insurer, after the policy has been in force for a stated period, from:

a.Ever raising premiums on the whole class of policyholders, even with regulatory approval
b.Requiring the insured to submit a written proof of loss before it pays any further claim
c.Denying a claim based on misstatements in the application (except fraudulent ones, where permitted)
d.Paying claim benefits on time, since this provision suspends all of the insurer's ordinary payment deadlines

Explanation

The time-limit-on-certain-defenses (incontestability) provision bars the insurer, after the policy has been in force for a set period (often two or three years), from voiding the policy or denying a claim because of misstatements made in the application, with an exception for fraudulent misstatements where state law allows. It does not restrict the insurer's right to adjust premiums for a whole class, nor does it eliminate the routine requirement that the insured submit proof of loss. Paying benefits on time is required by a separate provision (time of payment of claims), not this one.

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Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)
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