California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2245.2 - Reduction or Proration of Benefits on Account of Simultaneous Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At the option of the insurer, any U. C. D. policy may
						contain a provision relative to the reduction or proration of benefits on
						account of simultaneous coverage under the C. U. I. Code, but any provision
						shall be in one of the forms set forth in (a), (b), and (c) hereof only, or in
						the substance thereof. Connective words or phrases may be added, and there may
						be substituted for such words as "per day," "amount payable," and the like,
						other words or phrases more consistent with the other terminology used in the
						policy, but no such additions or substitutions shall be such as to change the
						substantive effect of the specified provisions.
Form (a) shall be used if the additional benefit while
						confined to a hospital as provided in the U. C. D. policy is the amount per day
						provided in the C. U. I. Code for additional benefits during hospital
						confinement. Form (b) shall be used if the additional benefits while confined
						to a hospital as provided in the U. C. D. policy is more than such amount per
						day. There shall be inserted in the blank space in form (a) and in the second
						blank space in form (b) the amount of the additional benefit during hospital
						confinement provided at the time of the issuance of the policy by the C. U. I.
						Code, and in the first blank space in form (b) there shall be inserted the
						amount by which the additional benefit per day while confined to a hospital
						exceeds the amount of the additional benefit during hospital confinement as
						provided in the C. U. I. Code. Form (c) shall be used if the insurer desires,
						on account of simultaneous coverage, to reduce or prorate basic U. C. D.
						benefits for loss of time as well as the additional benefits while confined to
						a hospital. Any of such forms (a), (b) or (c) may, by the terms of the U. C. D.
						policy, be made applicable to all employees, or to specified classes of
						employees determined by conditions pertaining to their employment, or to
						certain specific causes of disability objectively described, or to both such
						specified classes of employees and such specified causes of disability. From
						form (c) there may be omitted paragraph (1) in those cases in which the
						provision is made applicable only to a specified class or classes of employees
						which by the terms of the policy are entitled to the same benefits to which
						they would be entitled under the C. U. I. Code were they not covered by any
						voluntary plan.
Forms:
(a) In
					 case of any day of hospital confinement for which an employee entitled to
					 benefits hereunder is simultaneously covered by one or more other plans
					 (including voluntary plans and the State Unemployment Compensation Disability
					 Fund) and is accordingly entitled to other "additional benefits during hospital
					 confinement" on account of the same disability, then the $__________per day
					 otherwise payable hereunder shall be divided by the number of plans (including
					 voluntary plans and the State Unemployment Compensation Disability Fund) under
					 which he is simultaneously entitled to "additional benefits during hospital
					 confinement" and the quotient shall be the amount payable hereunder for such
					 day of confinement.
(b) In case of
					 any days of hospital confinement for which an employee entitled to benefits
					 hereunder is simultaneously covered by one or more other plans (including
					 voluntary plans and the State Unemployment Compensation Disability Fund) and is
					 accordingly entitled to other "additional benefits payable during hospital
					 confinement" on account of the same disability, the amount of the "additional
					 benefits payable during hospital confinement" payable hereunder for such day of
					 hospital confinement shall be $__________ plus the quotient of
					 $__________divided by the number of plans (including voluntary plans and the
					 State Unemployment Compensation Disability Fund) under which he is
					 simultaneously entitled to "additional benefits on account of hospital
					 confinement."
(c) In case of any
					 period for which an employee entitled to benefits hereunder is simultaneously
					 covered by one or more other plans (including voluntary plans and the State
					 Unemployment Compensation Disability Fund) and entitled to other Unemployment
					 Compensation Disability benefits on account of the same disability, the amount
					 payable for such period shall be:
(1) The
					 amount, if any, by which the benefits to which the employee otherwise would
					 have been entitled under this policy exceed the benefits to which he would have
					 been entitled under the C. U. I. Code if he were not covered by any voluntary
					 plan, plus
(2) The quotient of the
					 amount of benefits to which the employee would have been entitled under the C.
					 U. I. Code if he were not covered by any voluntary plan divided by the number
					 of plans (including voluntary plans and the State Unemployment Compensation
					 Disability Fund) under which he is simultaneously entitled to
					 benefits.