Health · Chapter 18 · NAIC Model Law
Uniform Individual Accident & Sickness Policy Provisions (NAIC)
Definition
NAIC model law adopted by nearly all states standardizing individual health contract wording: 12 MANDATORY provisions (must appear in every individually underwritten contract, protect the insured) and 11 OPTIONAL provisions (insurer may include, protect the insurer by defining — and thereby limiting — its rights). Insurers may reword only with state approval, and never with language less favorable to the insured.
In plain English
One rulebook so every individual health policy speaks the same language: 12 clauses the company MUST include (for you), 11 it MAY include (for itself).
Exam tip
Who benefits? Mandatory → the insured. Optional → the insurer. That single question sorts almost every provision question on the exam.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
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