Health Insurance Policy Provisions and Benefits
Mandatory provisions
The uniform provisions set the policy skeleton: entire contract and changes; time limit on certain defenses (two years); grace period (7 days if premiums are weekly, 10 if monthly, 31 otherwise); reinstatement; notice of claim (20 days); proof of loss (90 days); time of payment of claims (immediately or within 15 days); payment of claims; physical examination; legal actions (three years); change of occupation; misstatement of age; other insurance with the same insurer; illegal occupation; unpaid premium; cancellation.
Optional provisions and benefits
Coordination of benefits, subrogation, conversion, the consideration clause, and benefit provisions for hospital, surgical, maternity, mental health, prescription drug, and preventive care.
Washington specifics
State mandates apply to policies issued in Washington and include mental health parity, autism spectrum disorder treatment, maternity and newborn care, contraceptive coverage, diabetes supplies and education, chiropractic and naturopathic services, and gender-affirming care. Mandates raise premium, which is why mandate debates frame cost against access.
Traps
Time-limit questions are the most common. Notice of claim is 20 days, proof of loss is 90 days, payment is 15 days, and suit must be filed within three years. Do not import the life insurance two-year contestable period into a health policy question about preexisting conditions.
Rule of thumb: notice 20, proof 90, pay 15, sue 3 years.