California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 4 - Blanket Disability and Tuition Refund Policies › Section 2236.3 - Provisions Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  Uniform Provisions for group disability insurance and the Instructions for
				  their use, and the definition of words set forth in Sections
				  2232.1 to
				  2232.41, inclusive, of Article 2a
				  of Title 10, insofar as applicable, shall be required and shall apply to
				  disability policies; except that insofar as applicable to blanket disability
				  policies such Uniform Provisions and Instructions for their use are hereby
				  amended in the following respects:
(1) In a
				  tuition refund policy in place of using the Uniform Provision captioned
				  "Payment of Claims" the insurer may use one of the following provisions:
Form A. Payment of Claims
All benefits provided in this policy will be paid to the
					 school hereby insured immediately after receipt of due proof of loss in
					 repayment for the return of, or in payment of, tuition, fees, or charges of the
					 school for the period of attendance of the pupil lost by reason of disability
					 covered by this policy.
Form B. Payment of Claims.
All benefits provided in this policy will be paid
					 immediately after receipt of due proof of loss, to the person paying tuition
					 charges for the pupil suffering disability covered by this
					 policy.
(2) In blanket
				  disability policies issued to provide accidental death benefits, the insurer,
				  in place of using the first paragraph of the Uniform Provision captioned
				  "Payment of Claims," may use the following provisions, in which case no
				  provision may be included in the policy whereby the individual insured may
				  appoint a beneficiary:
Payment of Claims.
Indemnity for loss of life of a minor insured will be
					 payable to the minor insured's parents or guardians, if surviving the insured,
					 otherwise to the estate of the insured. Indemnity for loss of life of any other
					 insured will be payable to the estate of the insured. Any other accrued
					 indemnities unpaid at the insured's death may, at the option of the insurer, be
					 paid either to the parents guardians or estate of the insured. All other
					 indemnities, will be payable to insured.
The instructions for the use of said Uniform Provision in
					 group disability policies are also applicable to the above form. In such
					 blanket disability policies, the insurer shall omit the Uniform Provision
					 captioned "Change of Beneficiary" if the last above form of alternative Uniform
					 Provision captioned "Payment of Claims" is used.
(3)
(i) In
				  blanket disability policies issued to provide hospital, medical or surgical
				  benefits resulting from accidents or sickness, in lieu of the first paragraph
				  of the Uniform Provision captioned "Payment of Claims," the insurer may the
				  following paragraph:
All indemnities of this policy shall be payable to the
					 insured and any accrued indemnities unpaid at the death of the insured
					 (*) may be paid to the estate of the deceased
					 (*).
(3)
(ii) In
				  lieu of the second and third paragraphs of said Uniform Provision captioned
				  "Payment of Claims," the insurer may use the following paragraphs: If any
				  indemnity of this policy shall be payable to the estate of any insured
				  (*), or to an insured (*)
				  who is a minor or in the judgment of the insurer otherwise not competent to
				  give valid release, the insurer may pay such indemnity to the person
				  responsible for the insured's (**) support. Any
				  payments made by the insurer in good faith pursuant to this provision shall
				  fully discharge the insurer to the extent of such payment.
All or a portion of any indemnities provided by this policy
					 on account of hospital, nursing, medical or surgical services may, at the
					 insurer's option, and unless a person to whom benefits might otherwise be
					 payable thereunder requests otherwise in writing not later than the time for
					 filing proof of such loss, be paid directly to the hospital or person rendering
					 such services; but it is not required that the services be rendered by a
					 particular hospital or person.
__________
* Insurer shall insert the
					 proper word or words to describe the individual or individuals insured.
** Insurer shall insert in blank
					 space the proper word or words to describe the individual or individuals
					 insured.