State Codes and Statutes

Statutes > North-carolina > Chapter_58 > GS_58-51-5

§ 58‑51‑5.  Formof policy.

(a)        No policy ofaccident and health insurance shall be delivered or issued for delivery to anyperson in this State unless:

(1)        The entire money andother considerations therefor are expressed therein; and

(2)        The time at whichthe insurance takes effect and terminates is expressed therein; and

(3)        It purports toinsure only one person, except that a policy may insure, originally or bysubsequent amendment, upon the application of an adult member of a family whoshall be deemed the policyholder, any two or more eligible members of thatfamily, including husband, wife, dependent children or any children under aspecified age which shall not exceed 19 years and any other persons dependentupon the policyholder; and

(4)        The style, arrangement,and overall appearance of the policy, any endorsements, or attached papers giveno undue prominence to any portion of the text. For the purpose of thissubdivision, "text" includes all printed matter except the name andaddress of the insurer, the name or title of the policy, and captions andsubcaptions.

(5)        The exceptions andreductions of indemnity are set forth in the policy and, except those which areset forth in G.S. 58‑51‑15, are printed, at the insurer's option,either included with the benefit provision to which they apply, or under anappropriate caption such as "EXCEPTIONS," or "EXCEPTIONS ANDREDUCTIONS," provided that if an exception or reduction specificallyapplies only to a particular benefit of the policy, a statement of such exceptionor reduction shall be included with the benefit provision to which it applies;and

(6)        Each such form,including riders and endorsements, shall be identified by a form number in thelower left‑hand corner of the first page thereof; and

(7)        It contains noprovision purporting to make any portion of the charter, rules, constitution,or bylaws of the insurer a part of the policy unless such portion is set forthin full in the policy, except in the case of the incorporation of, or referenceto, a statement of rates or classification of risks, or short‑rate tablefiled with the Commissioner.

(8)        It contains noprovision excluding from coverage claims that are subject to the Workers'Compensation Act, Article 1 of Chapter 97 of the General Statutes, unless theexclusion extends to only specific medical charges for which the employee,employer, or carrier is liable or responsible according to a final adjudicationof the claim under that Article or an order of the North Carolina IndustrialCommission approving a settlement agreement entered into under that Article.

(b)        If any policy isissued by an insurer domiciled in this State for delivery to a person residingin another state, and if the official having responsibility for theadministration of the insurance laws of such other state shall have advised theCommissioner that any such policy is not subject to approval or disapproval bysuch official, the Commissioner may by ruling require that such policy meet thestandards set forth in subsection (a) of this section and in G.S. 58‑51‑15.(1913, c. 91, s.2; C.S., s. 6478; 1945, c. 385; 1953, c. 1095, s. 1; 1979, c. 755, s. 8; 2001‑216,s. 4; 2001‑487, s. 102(b).)

State Codes and Statutes

Statutes > North-carolina > Chapter_58 > GS_58-51-5

§ 58‑51‑5.  Formof policy.

(a)        No policy ofaccident and health insurance shall be delivered or issued for delivery to anyperson in this State unless:

(1)        The entire money andother considerations therefor are expressed therein; and

(2)        The time at whichthe insurance takes effect and terminates is expressed therein; and

(3)        It purports toinsure only one person, except that a policy may insure, originally or bysubsequent amendment, upon the application of an adult member of a family whoshall be deemed the policyholder, any two or more eligible members of thatfamily, including husband, wife, dependent children or any children under aspecified age which shall not exceed 19 years and any other persons dependentupon the policyholder; and

(4)        The style, arrangement,and overall appearance of the policy, any endorsements, or attached papers giveno undue prominence to any portion of the text. For the purpose of thissubdivision, "text" includes all printed matter except the name andaddress of the insurer, the name or title of the policy, and captions andsubcaptions.

(5)        The exceptions andreductions of indemnity are set forth in the policy and, except those which areset forth in G.S. 58‑51‑15, are printed, at the insurer's option,either included with the benefit provision to which they apply, or under anappropriate caption such as "EXCEPTIONS," or "EXCEPTIONS ANDREDUCTIONS," provided that if an exception or reduction specificallyapplies only to a particular benefit of the policy, a statement of such exceptionor reduction shall be included with the benefit provision to which it applies;and

(6)        Each such form,including riders and endorsements, shall be identified by a form number in thelower left‑hand corner of the first page thereof; and

(7)        It contains noprovision purporting to make any portion of the charter, rules, constitution,or bylaws of the insurer a part of the policy unless such portion is set forthin full in the policy, except in the case of the incorporation of, or referenceto, a statement of rates or classification of risks, or short‑rate tablefiled with the Commissioner.

(8)        It contains noprovision excluding from coverage claims that are subject to the Workers'Compensation Act, Article 1 of Chapter 97 of the General Statutes, unless theexclusion extends to only specific medical charges for which the employee,employer, or carrier is liable or responsible according to a final adjudicationof the claim under that Article or an order of the North Carolina IndustrialCommission approving a settlement agreement entered into under that Article.

(b)        If any policy isissued by an insurer domiciled in this State for delivery to a person residingin another state, and if the official having responsibility for theadministration of the insurance laws of such other state shall have advised theCommissioner that any such policy is not subject to approval or disapproval bysuch official, the Commissioner may by ruling require that such policy meet thestandards set forth in subsection (a) of this section and in G.S. 58‑51‑15.(1913, c. 91, s.2; C.S., s. 6478; 1945, c. 385; 1953, c. 1095, s. 1; 1979, c. 755, s. 8; 2001‑216,s. 4; 2001‑487, s. 102(b).)


State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_58 > GS_58-51-5

§ 58‑51‑5.  Formof policy.

(a)        No policy ofaccident and health insurance shall be delivered or issued for delivery to anyperson in this State unless:

(1)        The entire money andother considerations therefor are expressed therein; and

(2)        The time at whichthe insurance takes effect and terminates is expressed therein; and

(3)        It purports toinsure only one person, except that a policy may insure, originally or bysubsequent amendment, upon the application of an adult member of a family whoshall be deemed the policyholder, any two or more eligible members of thatfamily, including husband, wife, dependent children or any children under aspecified age which shall not exceed 19 years and any other persons dependentupon the policyholder; and

(4)        The style, arrangement,and overall appearance of the policy, any endorsements, or attached papers giveno undue prominence to any portion of the text. For the purpose of thissubdivision, "text" includes all printed matter except the name andaddress of the insurer, the name or title of the policy, and captions andsubcaptions.

(5)        The exceptions andreductions of indemnity are set forth in the policy and, except those which areset forth in G.S. 58‑51‑15, are printed, at the insurer's option,either included with the benefit provision to which they apply, or under anappropriate caption such as "EXCEPTIONS," or "EXCEPTIONS ANDREDUCTIONS," provided that if an exception or reduction specificallyapplies only to a particular benefit of the policy, a statement of such exceptionor reduction shall be included with the benefit provision to which it applies;and

(6)        Each such form,including riders and endorsements, shall be identified by a form number in thelower left‑hand corner of the first page thereof; and

(7)        It contains noprovision purporting to make any portion of the charter, rules, constitution,or bylaws of the insurer a part of the policy unless such portion is set forthin full in the policy, except in the case of the incorporation of, or referenceto, a statement of rates or classification of risks, or short‑rate tablefiled with the Commissioner.

(8)        It contains noprovision excluding from coverage claims that are subject to the Workers'Compensation Act, Article 1 of Chapter 97 of the General Statutes, unless theexclusion extends to only specific medical charges for which the employee,employer, or carrier is liable or responsible according to a final adjudicationof the claim under that Article or an order of the North Carolina IndustrialCommission approving a settlement agreement entered into under that Article.

(b)        If any policy isissued by an insurer domiciled in this State for delivery to a person residingin another state, and if the official having responsibility for theadministration of the insurance laws of such other state shall have advised theCommissioner that any such policy is not subject to approval or disapproval bysuch official, the Commissioner may by ruling require that such policy meet thestandards set forth in subsection (a) of this section and in G.S. 58‑51‑15.(1913, c. 91, s.2; C.S., s. 6478; 1945, c. 385; 1953, c. 1095, s. 1; 1979, c. 755, s. 8; 2001‑216,s. 4; 2001‑487, s. 102(b).)