Mississippi Administrative Code › Title 19 - Department of Insurance › Part 4 - Automobile Insurance › Chapter 2 - (2002-1) Non-Stacking Uninsured Motorist Insurance Coverage › Rule 19-4-2.07 - Appendix A-Approved Form - Effective 7/1/13

Current through June 25, 2024
THIS FORM TO BE USED WHEN INSURED SELECTS
				  NON-STACKING UM COVERAGE
MISSISSIPPI NON-STACKING UNINSURED MOTORIST
				  INSURANCE
Miss.
Code Ann
. §
									83-11-102
				  provides for an optional Non-stacking Uninsured Motorist Coverage available to
				  an insured under an auto liability policy that covers four (4) or more
				  vehicles. The Non-stacking Uninsured Motorist limits selected shall cover all
				  vehicles listed in the policy and does not apply per vehicle. The selection of
				  this Non-stacking coverage imposes a limitation on adding together or stacking
				  of coverages. If the insured selects the Non-stacking Uninsured Motorist
				  Policy, in the event of an accident, the total limit of uninsured motorist
				  coverage available from the policy will be only the one limit previously
				  selected by the insured. It is an alternative to stackable uninsured motorist
				  coverage where the coverage limits for each vehicle may be added together or
				  stacked to determine the total coverage available. While only one limit of
				  uninsured motorist coverage is available from a Non-stacking Uninsured Motorist
				  policy, other limits of uninsured motorist coverage from other policies might
				  be available to add to the single coverage available from the Non-stacking
				  Uninsured Motorist policy depending upon the specific circumstances.
The minimum limits required under Mississippi law for
				  Non-stacking Uninsured Motorist Coverage are four (4) times the limits required
				  by the Mississippi Motor Vehicle Safety Responsibility Law. Therefore, the
				  Non-stacking Uninsured Motorist Coverage limits pursuant to
Miss.
				  Code Ann
. §
									83-11-102
				  require $100,000 per person, $200,000 per accident and $100,000 for property
				  damage. An increase to the statutory limits under this Law shall increase the
				  minimum limits for Non-stacking Uninsured Motorist coverage accordingly.
I understand the limitations imposed by the Non-stacking
				  Uninsured Motorist policy and that such coverage is an alternative to coverage
				  without such limitation. I further agree that acceptance of this limitation
				  shall apply to any policy from the same insurer, including sister insurers in
				  the same holding company, which renews the coverage, extends the coverage, or
				  changes covered vehicles unless and until I make a written request for a change
				  to stackable uninsured motorist coverage.
Selection of Non-stacking Uninsured Motorist coverage is
				  affirmed by your signature below. I select the following coverages at the
				  limits shown below:
* Non-stackable UM Bodily Injury and UM Property Damage at
				  limits of___________ per person / _________per accident / _________property
				  damage.
* Non-stackable UM Bodily Injury Coverage (No Property
				  Coverage) at limits of per person / ___________per accident.
* Non-stackable Combined Single-limit UM Coverage (Includes
				  Bodily Injury and Property Damage Coverage together) at the limit of
				  _____________per accident.
Date: ___________ Policy Number (if available):
Applicant Name (Print):_________ Address:__________
Signature of Applicant:_____________ Proposed Effective Date
				  of Coverage:
Amended Form (Effective 7/1/2013)
House Bill 545, 2013
				  Regular Session; Miss. Code Ann. §
										83-11-102
				  (Rev. 2011)