Legislation
SECTION 3453*3
Employer sponsored group personal excess insurance
Insurance (ISC) CHAPTER 28, ARTICLE 34
* § 3453. Employer sponsored group personal excess insurance. (a) For
purposes of this section, the following definitions shall apply:
(1) "Certificate" or "certificate of insurance" means any policy,
contract or other evidence of insurance, or rider or endorsement
thereto, issued to a group member under an employer sponsored group
personal excess insurance policy.
(2) "Conditional renewal" means any change of limits, change in type
of coverage, reduction or elimination of coverage, increased deductible
or addition of exclusion, or increased premiums in excess of ten percent
(exclusive of any premium increase generated as a result of experience
rating, loss rating or retrospective rating).
(3) "Employee" means a director of the employer, or an individual or
partner who receives or has received income, wages or salaries from the
employer.
(4) "Employer" means a person, partnership, corporation or other
entity which pays or has paid income, wages or salaries to a person or
persons.
(5) "Employer sponsored group personal excess insurance" means a group
policy of insurance providing the kind of insurance defined in paragraph
thirteen or fourteen of subsection (a) of section one thousand one
hundred thirteen of this chapter, written as an excess policy with
premiums remitted by the employer, insuring groups of active and/or
retired employees designated by the employer.
(6) "Group member" means a designated active or retired employee
insured under this section and also may include the employee's domestic
partner or any person related to the employee by blood, marriage,
adoption, or operation of law, who resides in the same household
(including a ward or foster child) or who is a dependent child away at
school.
(7) "Group policy" means employer sponsored group personal excess
insurance written for the designated employees of an employer or other
group members as defined in this section.
(b) Employer sponsored group personal excess insurance may be written
in this state pursuant to this section.
(c) The premium for the group policy may be paid by the employer from
funds contributed:
(1) wholly by the employer;
(2) wholly by the employees or group members; or
(3) jointly by the employer and employees or group members.
(d) An employee or group member shall have the right to refuse
coverage offered by an employer under this section.
(e) Each policy written pursuant to this section shall provide
separate limits of coverage for each group member.
(f)(1) The insurer shall be responsible for the mailing or delivery to
the employer a group policy and certificates of insurance for each group
member insured under the group policy. The insurer shall also be
responsible for the mailing or delivery to the employer for each group
member any amended certificate of insurance, or endorsement to the
certificate, whenever there is a change of limits; addition, reduction,
or elimination of coverage; or addition of an exclusion, under the group
policy or certificate.
(2) The certificate shall contain in substance all material terms and
conditions of coverage afforded to the group member, including, but not
limited to, the disclosure in clear and easily understandable language
of any limitations, exclusions or required underlying coverages, unless
the group policy is incorporated by reference and a copy of the group
policy accompanies the certificate.
(g)(1) A group policy or certificate shall not be subject to section
three thousand four hundred twenty-five or section three thousand four
hundred twenty-six of this article. The following requirements shall
apply to authorized insurers in regard to termination of coverage.
(2) A group policy or certificate may be cancelled by an insurer only
if cancellation is based on one or more of the reasons set forth in
paragraph one of subsection (c) of section three thousand four hundred
twenty-six of this article, provided, however, that an individual group
member may also be canceled upon termination of his or her employment
with the employer.
(3) An insurer's cancellation of a group policy, or any certificate,
shall not become effective until forty-five days, or twenty days if
based upon non-payment of premium, after the insurer mails or delivers
written notice of cancellation to the employer at the mailing address
shown in the policy. The employer shall mail or deliver written notice
of such cancellation to each affected group member within ten days of
receiving a cancellation notice from the insurer advising the group
member of the cancellation and the effective date of the cancellation.
(h) An authorized insurer may nonrenew or conditionally renew a group
policy, or any certificate, under this section, for any reason upon
forty-five days written notice to the employer. The employer shall mail
or deliver written notice of such nonrenewal or conditional renewal to
each affected group member within ten days of receiving such notice from
the insurer.
(i) An employer may cancel a group policy, or any certificate, for any
reason upon thirty days written notice to the insurer and each affected
group member.
(j) Unless a group policy provides for a longer policy period, the
policy and all certificates shall be issued or renewed for a one-year
policy period commencing with a common inception date. A new employee
may be added to the group policy for less than one year to conform with
a common expiration date.
(k) No policy form shall be delivered or issued for delivery by an
authorized insurer unless it has been filed with the superintendent and
the superintendent has either approved it, or thirty days have elapsed
and the superintendent has not disapproved such form as misleading or
violative of public policy. The initial rate of filing pursuant to this
section shall be subject to the prior approval of the superintendent,
and any subsequent rate filing shall not be subject to prior approval.
* NB There are 3 § 3453's
purposes of this section, the following definitions shall apply:
(1) "Certificate" or "certificate of insurance" means any policy,
contract or other evidence of insurance, or rider or endorsement
thereto, issued to a group member under an employer sponsored group
personal excess insurance policy.
(2) "Conditional renewal" means any change of limits, change in type
of coverage, reduction or elimination of coverage, increased deductible
or addition of exclusion, or increased premiums in excess of ten percent
(exclusive of any premium increase generated as a result of experience
rating, loss rating or retrospective rating).
(3) "Employee" means a director of the employer, or an individual or
partner who receives or has received income, wages or salaries from the
employer.
(4) "Employer" means a person, partnership, corporation or other
entity which pays or has paid income, wages or salaries to a person or
persons.
(5) "Employer sponsored group personal excess insurance" means a group
policy of insurance providing the kind of insurance defined in paragraph
thirteen or fourteen of subsection (a) of section one thousand one
hundred thirteen of this chapter, written as an excess policy with
premiums remitted by the employer, insuring groups of active and/or
retired employees designated by the employer.
(6) "Group member" means a designated active or retired employee
insured under this section and also may include the employee's domestic
partner or any person related to the employee by blood, marriage,
adoption, or operation of law, who resides in the same household
(including a ward or foster child) or who is a dependent child away at
school.
(7) "Group policy" means employer sponsored group personal excess
insurance written for the designated employees of an employer or other
group members as defined in this section.
(b) Employer sponsored group personal excess insurance may be written
in this state pursuant to this section.
(c) The premium for the group policy may be paid by the employer from
funds contributed:
(1) wholly by the employer;
(2) wholly by the employees or group members; or
(3) jointly by the employer and employees or group members.
(d) An employee or group member shall have the right to refuse
coverage offered by an employer under this section.
(e) Each policy written pursuant to this section shall provide
separate limits of coverage for each group member.
(f)(1) The insurer shall be responsible for the mailing or delivery to
the employer a group policy and certificates of insurance for each group
member insured under the group policy. The insurer shall also be
responsible for the mailing or delivery to the employer for each group
member any amended certificate of insurance, or endorsement to the
certificate, whenever there is a change of limits; addition, reduction,
or elimination of coverage; or addition of an exclusion, under the group
policy or certificate.
(2) The certificate shall contain in substance all material terms and
conditions of coverage afforded to the group member, including, but not
limited to, the disclosure in clear and easily understandable language
of any limitations, exclusions or required underlying coverages, unless
the group policy is incorporated by reference and a copy of the group
policy accompanies the certificate.
(g)(1) A group policy or certificate shall not be subject to section
three thousand four hundred twenty-five or section three thousand four
hundred twenty-six of this article. The following requirements shall
apply to authorized insurers in regard to termination of coverage.
(2) A group policy or certificate may be cancelled by an insurer only
if cancellation is based on one or more of the reasons set forth in
paragraph one of subsection (c) of section three thousand four hundred
twenty-six of this article, provided, however, that an individual group
member may also be canceled upon termination of his or her employment
with the employer.
(3) An insurer's cancellation of a group policy, or any certificate,
shall not become effective until forty-five days, or twenty days if
based upon non-payment of premium, after the insurer mails or delivers
written notice of cancellation to the employer at the mailing address
shown in the policy. The employer shall mail or deliver written notice
of such cancellation to each affected group member within ten days of
receiving a cancellation notice from the insurer advising the group
member of the cancellation and the effective date of the cancellation.
(h) An authorized insurer may nonrenew or conditionally renew a group
policy, or any certificate, under this section, for any reason upon
forty-five days written notice to the employer. The employer shall mail
or deliver written notice of such nonrenewal or conditional renewal to
each affected group member within ten days of receiving such notice from
the insurer.
(i) An employer may cancel a group policy, or any certificate, for any
reason upon thirty days written notice to the insurer and each affected
group member.
(j) Unless a group policy provides for a longer policy period, the
policy and all certificates shall be issued or renewed for a one-year
policy period commencing with a common inception date. A new employee
may be added to the group policy for less than one year to conform with
a common expiration date.
(k) No policy form shall be delivered or issued for delivery by an
authorized insurer unless it has been filed with the superintendent and
the superintendent has either approved it, or thirty days have elapsed
and the superintendent has not disapproved such form as misleading or
violative of public policy. The initial rate of filing pursuant to this
section shall be subject to the prior approval of the superintendent,
and any subsequent rate filing shall not be subject to prior approval.
* NB There are 3 § 3453's