reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.9 - Standards for Determining Whether Benefits of an Individual Hospital, Medical or Surgical Policy Are Unreasonable in Relation to the Premium Charged Pursuant to Subdivision (c) of Section 10293 › Section 2222.16 - Consideration of Relevant Factors

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In reviewing any specific policy the commissioner shall
					 consider all factors as are relevant to a determination as to whether the
					 benefits are unreasonable in relation to the premium charged therefor. Relevant
					 factors and the weight to be given thereto depend upon the attributes of such
					 particular policy, as determined by the commissioner in accordance with the
					 provisions of this article. The following is a list of relevant factors which
					 are generally applicable to policies subject to this statute:
(a) Policy experience generated over the
				  period of the one preceding calendar year (ending with the beginning of the
				  year of review) in addition to the year of review may be considered as relevant
				  in case of any policy form. Experience generated over a still longer period
				  (ending with the year of review) may be considered in case of any policy as to
				  which there are substantial reasons to believe, insofar as loss experience is
				  relevant to the issue to be determined, that the experience statistics for the
				  shorter period do not give a fair indication of the actual loss experience of
				  the policy under review. Experience over such extended periods can be
				  considered only if relevant experience figures are made available to the
				  commissioner.
(b) Adjustment of
				  experience statistics to conform to assumption of payment of premiums annually
				  in advance. The adjustment will be that the annual premium shall be deemed to
				  be an amount which is:
(1) 96 percent of the
				  sum of semiannual premiums;
(2) 94
				  percent of the sum of quarterly premiums; or
(3) 92 1/2 percent of the sum of monthly
				  premiums.
If the insurer desires consideration of the increase in
					 handling expenses arising from fractional premium payments, the insurer must
					 furnish for the experience period (i) the distribution of earned premiums
					 according to mode of premium payment during the year, and (ii) adjusted
					 experience statistics based upon conforming earned premiums related to premiums
					 collected semiannually, quarterly, monthly, and upon a weekly and monthly debit
					 basis to the earned premiums developed from the corresponding pro rata annual
					 premium.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.9 - Standards for Determining Whether Benefits of an Individual Hospital, Medical or Surgical Policy Are Unreasonable in Relation to the Premium Charged Pursuant to Subdivision (c) of Section 10293 › Section 2222.17 - Notice to Insurer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If after consideration of all relevant factors the
					 commissioner believes that the benefits provided under an individual hospital,
					 medical or surgical policy are not reasonable in relation to the premium
					 charged, the commissioner shall so inform the insurer in writing. Such
					 notification shall be deemed a confidential communication. The commissioner
					 shall also advise the insurer that the commissioner will, at the commissioner's
					 discretion, commence proceedings for withdrawal of authorization of the form
					 after notice and hearing as provided by law unless, within 31 days from the
					 date of the notification, the insurer commits itself in writing to the
					 commissioner that it will, within 90 days, voluntarily either (1) cease further
					 issuance of the policy form or (2) increase benefits under the policy in
					 relation to the premiums charged in an amount sufficient to bring the policy
					 into compliance with the standards of reasonability provided for in section
					 2222.12. If the insurer does not
					 commit itself, within 31 days from the date of the notification, to discontinue
					 issuing the policy or increase benefits under the policy in relation to
					 premiums charged, the commissioner may commence proceedings at any time as
					 provided by law for withdrawal of the authorization of the policy
					 form.
1. Amendment
					 of section and new NOTE filed 12-29-2006; operative 3-29-2007 pursuant to
					 Insurance Code section
					 10293(a)
					 (Register 2006, No. 52).
Note: Authority cited: Section
						10293,
						Insurance Code. Reference: Section
						10293(a),
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.9 - Standards for Determining Whether Benefits of an Individual Hospital, Medical or Surgical Policy Are Unreasonable in Relation to the Premium Charged Pursuant to Subdivision (c) of Section 10293 › Section 2222.18 - When Resubmission Deemed to be Same as Withdrawn Policy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The commissioner may consider two or more forms of the
					 policy contracts as prepared by any one insurer or two or more affiliated
					 insurers as one policy form for the purpose of determining under the provisions
					 of this article whether benefits are reasonable in relation to premiums if the
					 benefits and premiums or premium rates of such policy forms are alike in
					 substance. Any policy form submitted by an insurer to replace a form of itself
					 or its affiliates, the approval of which has been withdrawn under the
					 provisions of this article, shall not be considered to be a new form or a form
					 different from that of the form the approval of which was withdrawn, unless the
					 benefits of the new form are sufficiently more favorable to the insured, or the
					 premium or premium rates are sufficiently lower so as to indicate that the new
					 form will meet the tests of this article.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.9 - Standards for Determining Whether Benefits of an Individual Hospital, Medical or Surgical Policy Are Unreasonable in Relation to the Premium Charged Pursuant to Subdivision (c) of Section 10293 › Section 2222.19 - Statement of Compliance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Unless requested by the commissioner to provide more
					 specific information on policy forms subject to the standards of reasonability
					 in Section
					 2222.12, a company shall, by April
					 1 of each year, provide a statement from a qualified actuary that lists the
					 policy forms to which the standards apply, the lifetime anticipated loss ratio
					 and, if applicable, the lifetime anticipated disease management ratio for each
					 form, and a statement that the standards of reasonability have been met, for
					 each policy form for the preceding calendar year. For policy forms to which
					 Section 2222.12(a)
					 applies, a company shall also submit by April 1 of each year a schedule
					 detailing disease management expenses for the preceding calendar year, if
					 applicable.
1. New
					 subsection (5) filed 4-5-78; designated effective 1-1-79 (Register 78, No.
					 14).
2. Amendment of section heading, repealer and new section and
					 amendment of NOTE filed 12-29-2006; operative 3-29-2007 pursuant to Insurance
					 Code section
					 10293(a)
					 (Register 2006, No. 52).
Note: Authority cited: Sections
						10293 and
						10608,
						Insurance Code. Reference: Section
						10293(a),
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2 - Group Disability Policies [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer of
				  Article 2 (Sections
				  2223 through
				  2232) filed 5-6-77 as procedural
				  and organizational; effective upon filing (Register 77, No. 19). For prior
				  history, see Registers 3; 10, No. 5; and 20, No. 5.
Note: Authority cited: Section
					 10270.93,
					 Insurance Code. Reference: Sections
					 10270-
					 10278,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.1 - Applicability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This article is applicable to all group disability
						insurance policies delivered or issued for delivery in this State on or after
						January 1, 1957, and to all such policies which the issuing insurer elects,
						before that date, to draft in compliance with the requirements of this article
						in lieu of incorporating therein the standard provisions promulgated for group
						disability policies as set forth in Article 2 of this subchapter. No group
						disability policy may be issued hereafter and until January 1, 1957, unless it
						contains, in accordance with the instructions for their use, either the
						standard provisions set forth in Article 2 of this subchapter or the uniform
						provisions set forth in this article. (Ins. C. 10270.94).
1. New
						Article 2a (Sections
						2232.1 through
						2232.41) filed 4-4-56; effective
						thirtieth day thereafter (Register 56, No. 6).
2. Change without
						regulatory effect adopting subarticle 1 heading and removing subject heading
						filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.0.52
Note: Authority cited for Article 2a (Sections
						  2232.1 through
						  2232.41), Section
						  10270.94 Insurance
						  Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.2 - Provisions Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every group disability policy subject to this article
						which is delivered or issued for delivery in this State shall contain certain
						uniform provisions which shall be set forth in the policy in accordance with
						the requirements and provisions of this article. (Ins. C.
						10270.9.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.3 - Required Changes in Uniform Language

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If any compulsory or optional uniform provision set forth
						in Section
						2232.8 or in Sections
						2232.16 to
						2232.40, inclusive of this article
						is in whole or in part inapplicable to or inconsistent with the coverage
						provided in the policy, the insurer shall, with the approval of the
						commissioner, either omit entirely from the policy or modify any inapplicable
						provision or alternative provision, or shall modify any inconsistent provision
						or alternative provision in such manner as to make the provision as contained
						in the policy consistent with the coverage so provided. (Ins. C.
						10323.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.4 - Order of Uniform Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The compulsory and optional uniform provisions set forth
						in Section
						2232.8 or Sections
						2232.16 to
						2232.40 of this article, or any
						corresponding provisions which are used in lieu thereof in accordance with this
						article, shall, in accordance with the instructions for their use, be set forth
						in the consecutive order in which the compulsory and optional uniform
						provisions are hereinafter set forth in Sections
						2232.16 to
						2232.40 of this article, or at the
						option of the insurer any such provision may appear as a unit in any part of
						the policy with other provisions with which it may be logically related,
						providing the resulting policy shall not be in whole or in part unintelligible,
						uncertain, ambiguous, abstruse, or likely to mislead the policyholder or any
						person insured thereunder. (Ins. C. 10324.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.5 - Explaining Variations in Order and Wording

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If any group disability policy subject to this article
						submitted for approval sets forth the uniform provisions therein in any order
						or under any captions other than in the order or alternative order and under
						the captions or alternative captions as set forth in or specifically permitted
						by this article, or if any language for any of said uniform provisions is used
						other than the language or alternative language of the uniform provisions set
						forth in this article with only such changes therein as may be necessary to
						make such language harmonize with the terminology and the benefits of the
						policy, then in such case, the insurer in its letter submitting any such form,
						shall point out each such variation of order, caption or language, explaining
						the differences therein from the order, caption or language, as the case may
						be, prescribed by this article, the reason therefor, and why the insurer
						believes the order, caption or language of the provision as set forth in the
						policy is, in each case, not less favorable to the policyholder or any
						individual insured under the policy than the order, caption or language of the
						corresponding provision as prescribed by this article. (Ins. C.
						10327.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.6 - Compliance with Uniform Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No group disability policy provision which is not a
						subject of Sections
						2232.16 to
						2232.40, inclusive, of this
						article shall make any policy subject to this article or any portion thereof
						less favorable in any respect to the policyholder, to any person insured
						thereunder or to any beneficiary than the provisions which are subject to this
						article. (Ins. C. 10328.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.9 - Order Conforms to Insurance Code

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The compulsory and optional uniform provisions for group
						disability insurance are set forth in this article in the order in which the
						corresponding provisions are set forth in the Insurance Code, and for purposes
						of identification and uniform reference, they are given substantially the same
						captions as the corresponding provisions in the Insurance Code. (Ins. C.
						10270.94.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.10 - Provisions Contain Instructions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Following each of the compulsory and optional uniform
						provisions set forth in this article are instructions for their use. In case no
						uniform provision corresponding to a particular provision as set forth in the
						Insurance Code is set forth in this article, the instructions indicate the
						rules with respect to the subject matter of that uniform provision which must
						be conformed to in all group disability policies subject to this article. (Ins.
						C. 10270.94.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.11 - Designation of Matters to be Omitted or Added

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Unless the context otherwise requires, portions of
						provisions enclosed in parentheses may be or are required to be omitted or
						added under the circumstances specified in the instructions for the use of that
						particular uniform provision. (Ins. C. 10270.94.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.12 - "Insurer" Includes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the word "insurer" is used in a uniform
						provision, there may be substituted therefor "company," " corporation,"
						"association... society," or such other word or words as will properly
						designate the insurer. (Ins. C. 10270.94.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.13 - "Policy" Includes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the word "policy" is used in this article
						reference is made to all riders, endorsements, or other forms which constitute
						or form a part of the contract of group disability insurance. Whenever the word
						"policy" is used in any of the uniform provisions, there may be substituted
						therefor the words "rider," endorsement, "contract" or other proper designation
						of the document to which the uniform provision applies. Whenever in any form of
						uniform provision as set forth in this article the expression "the policy" or
						"this policy" is used, the terminology may be used interchangeably, with
						variations in the use of the term "policy" as herein permitted, insofar as
						consistent with the other terminology of the policy and the substantive meaning
						of the promulgated provisions. (Ins. C. 10270.94.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.14 - "Employer" or "Policyholder" Includes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the word "employer" or "policyholder" is used in
						this article, unless the text otherwise requires, reference is made to any
						person to whom or to which the policy is issued. Whenever the word "employer"
						or "policyholder" is used in any uniform provision, there may be substituted
						therefor the words "executive officer," "association," "trustee" or other
						proper designation of the person making application, if any, for the policy or
						to whom or to which the policy is issued. (Ins. C. 10270.94.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 1 - General Instructions and Rules › Section 2232.15 - "Employee" Includes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the word "employee" is used in this article
						reference is made to any individual who has been, or is eligible to be insured
						under the policy with respect to that individual, that individual's spouse or
						that individual's dependents. Whenever the word "employee" is used in any
						uniform provision, there may be substituted therefor the word "member" or other
						proper designation of the individual, other than spouse or dependent, insured
						under a policy. (Ins. C. 10270.94.)
1. Change
						without regulatory effect amending section filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.16 - Compulsory Uniform Provision Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Except as otherwise provided in Section
						2232.1, each group disability
						policy delivered or issued for delivery to any person in this State shall
						contain the provisions or alternative provisions specified in Sections
						2232.17 to
						2232.28, inclusive, or in Section
						2232.8 hereof in the words therein
						set forth, subject, however, to the "General Instructions and Rules" hereof and
						the instructions as to its use following each such provision; provided,
						nevertheless, that the insurer may at its option, subject to Section
						2232.5 hereof, substitute for one
						or more of such provisions corresponding provisions of different wording
						approved by the commissioner, which are in each instance not less favorable in
						any respect to policyholder, any individual insured or any beneficiary. Such
						provisions shall be preceded individually by the caption appearing herein as
						the caption for each such provision or by such caption and subcaption as is
						herein specifically permitted, or at the option of the insurer and subject to
						Section 2232.5 hereof, by such appropriate
						individual or group captions or subcaptions as the commissioner may approve.
						(Ins. C. 10350.)
1. Change
						without regulatory effect adopting subarticle 2 heading and removing subject
						heading filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.0.52
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.19 - Grace Period

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A grace period of 31 days will be granted for the payment
						of premiums accruing after the first premium, during which grace period the
						policy shall continue in force, but the employer shall be liable to the insurer
						for the payment of the premium accruing for the period the policy continues in
						force.
Instructions
1. The termination of the group policy by the
					 mutual consent of the parties, express or implied, terminates the entire
					 contract, including the "Grace Period" uniform provision. Therefore, a
					 provision in the policy, otherwise lawful, to the effect that the termination
					 of the policy by the employer or by mutual consent, express or implied, of the
					 employer and insurer, effective as of a premium due date or during a period of
					 grace will terminate the period of grace for the payment of premiums as of the
					 date of such termination of the policy is not inconsistent with this uniform
					 provision.
2. The right of the
					 insurer to cut off the grace period on five days' written notice, which is
					 found in the corresponding individual uniform provision, is not applicable to
					 group insurance, since five days is not sufficient time to replace a group
					 policy, and this provision has been eliminated. Likewise, grace periods of
					 shorter than 31 days are inappropriate to the peculiar group situation, and no
					 provision for a shorter grace period has been permitted. Furthermore, it is
					 inconsistent with the nature of group insurance to allow coverage during a
					 grace period without requiring the payment of premiums accruing during such
					 period. It follows that premiums on group policies containing the above grace
					 period or its substance will continuously accrue until the policy is
					 terminated, and the insurer, acting alone, cannot cut off the right of the
					 employer to pay such accruing premiums on less than 31 days' notice. (Ins. C.
					 10350.3.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.20 - Reinstatement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
There shall be no provision in a group disability policy
						relative to reinstatement of the policy after lapse because of default in the
						payment of premium nor shall there be any provision therein prior to the
						reinstatement relative to when the insurance coverage becomes effective again
						after such lapse and reinstatement. (Ins. C. 10350.4.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.21 - Notice of Claim

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Written notice of claim must be given to the insurer
						within 20 days after the occurrence or commencement of any loss covered by the
						policy, or as soon thereafter as is reasonably possible. Notice given by or on
						behalf of the claimant to the insurer at ___ or to any authorized agent of the
						insurer, with information sufficient to identify the insured employee, shall be
						deemed notice to the insurer.
Instructions
1. In the blank space in this provision, the
					 insurer shall insert the location of such office or offices as it may designate
					 for the purpose of giving notice of claim.
2. The insurer may omit the second sentence
					 of this provision if in the normal course of its business it makes all
					 collections and services group disability accounts through its home office or
					 branch offices and not through life and disability agents, and if it has
					 conspicuously imprinted on the individual certificates (including supplemental
					 certificates) the name of the insurer and the address of its home office and
					 the address or addresses of the branch office or offices to which notice of
					 claim and proof of loss may be sent. (Ins. C. 10350.5.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.22 - Claims Forms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The insurer, upon receipt of a written notice of claim,
						will furnish to the claimant such forms as are usually furnished by it for
						filing proofs of loss. If such forms are not furnished within 15 days after the
						giving of such notice the claimant shall be deemed to have complied with the
						requirements of this policy as to proof of loss upon submitting, within the
						time fixed in the policy for filing proofs of loss, written proof covering the
						occurrence, the character and the extent of the loss for which claim is made.
						(Ins. C. 10350.6.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.23 - Proofs of Loss

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Written proof of loss must be furnished to the insurer,
						in case of claim for loss for which this policy provides any periodic payment
						contingent upon continuing loss, within 90 days after the termination of the
						period for which the insurer is liable, and in case of claim for any other
						loss, within 90 days after the date of such loss. Failure to furnish such proof
						within the time required shall not invalidate nor reduce any claim if it was
						not reasonably possible to give proof within such time, provided such proof is
						furnished as soon as reasonably possible and in no event, except in the absence
						of legal capacity of the employee, later than one year from the time proof is
						otherwise required.
Instructions
In any policy which provides both benefits payable
						periodically and benefits payable when they occur or as they accrue, the
						insurer shall make clear by the terms of the policy which benefits are to be
						paid as they accrue or when they occur. This may be done in any lawful manner.
						Either of the two following ways would be acceptable. First, the insurer may
						specify in the benefit clauses themselves those benefits which will be paid
						periodically and those which will be paid as they accrue or when they occur, in
						which case no change in the language of the uniform provision is required.
						Second, the insurer may, in lieu of the phrase "in case of claim for loss for
						which this policy provides any periodic payment contingent upon continuing
						loss," identify by name or description or by place reference the benefits which
						will be paid periodically, and leaving unchanged the provision that as to any
						other loss proof is required within 90 days after the date of the loss. (Ins.
						C. 10350.7.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.24 - Time of Payment of Claim

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Form A.
Indemnities payable under this policy for any loss other
						than loss for which this policy provides periodic payments will be paid (to the
						insured employee) as they accrue immediately upon receipt of due written proof
						of such loss. Subject to due written proof of loss, all accrued indemnity for
						loss for which this policy provides periodic payment will be paid (to the
						insured employee) and any balance remaining unpaid upon the termination of the
						period of liability will be paid immediately upon receipt of due written
						proof.
Form B.
Subject to due written proof of loss, all indemnities for
						loss for which this policy provides payment will be paid (to the insured
						employee) as they accrue and any balance remaining unpaid at termination of the
						period of liability will be paid (to the insured employee) immediately upon
						receipt of due written proof.
Instructions
1. The insurer may use Form A or Form B at
					 its option.
2. The insurer shall
					 insert in the blank space in Form A a period for payment which shall not be
					 less frequently than monthly.
3. If
					 the insurer has chosen to specify ind identify in the uniform provision
					 captioned "Proofs of Loss" the benefits for which proof of loss may be made
					 within 90 days after termination of the period for which the insurer is liable,
					 and if such insurer elects to use Form A, it shall in lieu of using the phrase
					 "any loss other than loss for which this policy provides periodic payment" and
					 "loss for which this policy provides periodic payment," specify and identify by
					 name or description or by place reference the benefits for which no periodic
					 payment is provided and benefits for which a periodic payment is
					 provided.
4. The insurer shall omit
					 the phrase in parentheses reading: "to the insured employee" if accidental
					 death benefits are included in the policy, in which case the first paragraph of
					 the uniform provision captioned "Payment of Claims" shall be used. (Ins. C.
					 10350.8.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.26 - Physical Examination and Autopsy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The insurer at its own expense shall have the right and
						opportunity to examine the person of any individual whose injury or sickness is
						the basis of claim when and as often as it may reasonably require during the
						Pendency of a claim hereunder and to make an autopsy in case of death, where it
						is not forbidden by law.
Instructions
1. The clause relative to the right of the
					 insurer to make an autopsy in case of death may be omitted from a policy which
					 provides no benefit for accidental death.
2. The entire provision may be omitted from a
					 policy which only provides one or more of the following benefits:
					 hospitalization, medical expenses or surgical operations. (Ins. C.
					 10350.10.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.27 - Legal Actions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No action at law or in equity shall be brought to recover
						on this policy prior to the expiration of 60 days after written proof of loss
						has been furnished in accordance with the requirements of this policy. No such
						action shall be brought after the expiration of three years after the time
						written proof of loss is required to be furnished. (Ins. C.
						10350.11.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 2 - Compulsory Uniform Provisions › Section 2232.28 - Change of Beneficiary

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The right to change of beneficiary is reserved to the
						insured employee, and the consent of the beneficiary or beneficiaries shall not
						be requisite to any change in beneficiary.
Instructions
The insurer shall omit this provision from any policy
						which makes no provision for the designation of a beneficiary. (Ins. C.
						10350.12.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.30 - Optional Uniform Provision Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No group disability policy subject to this article
						delivered or issued for delivery in this State shall contain provisions
						respecting any of the matters which are the subject of Sections
						2232.31 to
						2232.40, inclusive, unless such
						provisions are set forth in the policy in accordance with the requirements of
						such sections, and in the words, order and under the captions of the uniform
						provisions as set forth in Sections
						2232.32,
						2232.34,
						2232.37,
						2232.38,
						2232.39, and
						2232.40, subject, however, to the
						"General Instructions and Rules" of this article, provided, nevertheless, that
						the insurer may, at its option, subject to Section
						2232.5 hereof, substitute for one
						or more of such provisions corresponding provisions of different wording
						approved by the commissioner, which are in each instance not less favorable in
						any respect to the policyholder, any individual insured, or any beneficiary.
						Such provisions shall be preceded individually by the caption appearing herein
						as the caption for each such provision or by such other caption or subcaption
						as is herein specifically permitted, or, at the option of the insurer and
						subject to Section
						2232.5 hereof, by such appropriate
						individual or group captions or subcaptions as the commissioner may
						approve.
The Optional Uniform Provisions set forth in Article 5a,
						Chapter 4, Part 2, Division 2 of the Insurance Code for use in individual
						policies, which are captioned "Change of Occupation... Other Insurance in this
						Insurer," "Insurance With Other Insurers" as set forth in Section
						10369.6 of
						the Insurance Code, "Relation of Earnings to Insurance" and "Unpaid Premiums"
						are not applicable to group disability insurance. Insofar as they are not
						applicable because the subject matter of such provisions are not consistent
						with group disability insurance, no provision incorporating such subject matter
						shall be set forth in any group disability policy. The instructions under the
						heading for each optional uniform provision state whether or not, or to what
						extent the subject matter of each such uniform provision as set forth in the
						Insurance Code for use in individual policies may be used in group disability
						policies. (Ins. C. 10369.1.)
1. Change
						without regulatory effect adopting subarticle 3 heading and removing subject
						heading filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.0.52
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.31 - Change of Occupation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
There shall be no provision in a group disability policy,
						other than provisions relative to eligibility or amounts or extent of coverage
						based on a plan precluding individual selection, reducing or prorating
						insurance because of change of occupation of the policyholder or any of the
						individuals covered under the policy. (Ins. C. 10369.2.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.32 - Misstatement of Age

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Form A.
If the age of any individual covered under this policy
						has been misstated, the amount payable shall be such as the premium paid for
						the coverage of such individual would have purchased at the correct age.
Form B.
If the age of any individual covered under this policy
						has been misstated, there shall be an adjustment of the premium for this policy
						so that there shall be paid to the insurer the premium for the coverage of such
						individual at the individual's correct age, and the amount of the insurance
						coverage shall not be affected.
Instructions
1. The insurer may not use either Form A or
					 Form B unless the policy contains a schedule of premiums graded according to
					 the age of all or some of the persons insured under the policy.
2. The insurer may, without regard to this
					 uniform provision, include in a policy the premium for which is not determined
					 by the ages of any of the individuals covered, provisions relating the amounts
					 of insurance to the age of some or all of the individuals covered, and may
					 provide that the true age of any such individual shall determine the amount of
					 the individual's insurance coverage.
3. Subject to the foregoing instructions, the
					 insurer may, at its option, use either Form A or Form B as may be applicable.
					 (Iris. C. 10369.3, Cf. Ins. C. 10208.)
1. Change
						without regulatory effect amending section filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.33 - Other Insurance in this Insurer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as provided in Section
					 2232.34 and as may elsewhere
					 herein be otherwise provided, a provision in a group disability policy limiting
					 or reducing the amount of coverage thereunder because of other coverage in the
					 same insurer is not appropriate to or applicable for use in group disability
					 policies and no such provision may be used therein.
(b) Except as provided in Section
					 2232.34 and as may elsewhere
					 herein be otherwise provided, a provision in a group disability policy limiting
					 coverage thereunder and under other disability policies issued by the same
					 insurer to coverage under any one such policy is not appropriate to or
					 applicable for use in group disability policies and may not be used therein.
					 (Ins. C. 10369.4)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.35 - Policy Provisions Not Deemed to be Proration

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Notwithstanding the prohibitions of
					 Sections 2232.33 and
					 2232.34, an insurer may include in
					 the policy affirmative statements of coverage or affirmative provisions,
					 otherwise lawful, relating to the conditions of eligibility or the conditions
					 determining the amounts of insurance, which may refer to other insurance with
					 the same or another insurer, if the amount of coverage of the policy and the
					 individuals with respect to whom coverage is provided thereunder can be
					 determined with particularity for each period of time for which premium is paid
					 to the insurer, without having to take into consideration the probabilities of
					 other insurance not yet in effect or not yet disclosed, but which may in the
					 future become in effect or be disclosed, affecting the amounts of benefits
					 payable.
(b) Group policies or
					 contracts which are in force on January 1, 1975, and which contain either an
					 "excess" or a "non-duplication" provision, other than as specifically provided
					 in this section shall be brought into compliance with this section by the later
					 of the next annual renewal date of such policies or contracts, or the
					 expiration of a collectively bargained contract pursuant to which they were
					 written.
1.
						Amendment and new subsection (b) filed 11-29-74; designated effective January
						1, 1975 (Register 74, No. 48).
2. Amendment filed 5-6-77 as
						procedural and organizational; effective upon filing (Register 77, No.
						19).
Note: Authority cited: Section
						  10369.1,
						  Insurance Code. Reference: Sections
						  10369.1-
						  10369.12,
						  Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.36 - Relation of Earnings to Insurance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An insurer shall not include in any group disability
						policy any provision reducing or prorating benefits because of the earnings of
						the insured employee, other than as such earning may properly affect
						eligibility or amounts of coverage based on a plan precluding individual
						selection. (Ins. C. 10369.7.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.37 - Unpaid Premiums

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An insurer shall not include in any group disability
						policy any provision for the deduction of any premium or any portion thereof
						from any claim upon its payment. (Ins. C. 10369.8.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.39 - Conformity with State Statutes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any provision of this policy which, on its effective
						date, is in conflict with the statutes of the state in which this policy was
						delivered or issued for delivery is hereby amended to conform to the minimum
						requirements of such statute. (Ins.C. 10369.10.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.40 - Illegal Occupation or Commission of Felony

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The insurer shall not be liable for any loss to which a
						contributing cause was the commission of or attempt to commit a felony by the
						person whose injury or sickness is the basis of claim, or to which a
						contributing cause was such person's being engaged in an illegal occupation.
						(Ins. C. 10969.11.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 2a - Group Disability Policies › Subarticle 3 - Optional Uniform Provisions › Section 2232.41 - Intoxicants and Narcotics

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The insurer shall not be liable for any loss sustained or
						contracted in consequence of the person whose injury or sickness is the basis
						of claim being intoxicated or under the influence of any narcotic unless
						administered on the advice of a physician. (Ins. C.
						10369.12.)