ARTICLE10A

ACCIDENTAND HEALTH OR SICKNESS INSURANCE CONTRACTS

 

Note

 

Ā  Article heading amended by L 2002, c 155, Ā§48.

 

Cross References

 

Ā  Conformance to federal law, see Ā§431:2-201.5.

Ā  Federally qualified health centers; rural health clinics;reimbursement, see Ā§346-53.6.

Ā  Health maintenance organization act, see chapter 432D.

Ā  Medicaid-related mandates, see chapter 431L.

Ā  Mental health and alcohol and drug abuse treatment insurancebenefits, see chapter 431M.

Ā  Patients' bill of rights and responsibilities act, seechapter 432E.

Ā  Proposed mandatory health insurance coverage and assessmentreport, see Ā§Ā§23-51, 52.

Ā  State health insurance program, see chapter 431N.

 

Attorney General Opinions

 

Ā  Section 431:10A-601 applied to all parts of article 10A ifthe category of policy under consideration included family coverage, as definedin Ā§431:10A-103.Ā  Att. Gen. Op. 97-10.

Ā  The placement of Ā§431:10A-601 in this article, regulatingcontent of insurance contracts, makes clear that the legislative intent was tomandate benefits that must be made available by insurers that write contractsof insurance providing family coverage.Ā  Att. Gen. Op. 97-10.

 

PART I.Ā INDIVIDUAL ACCIDENT AND HEALTH

ORSICKNESS POLICIES

 

Note

 

Ā  Part heading amended by L 2002, c 155, Ā§48.

 

Attorney General Opinions

 

Ā  Section 431:10A-601 applied to all parts of article 10A ifthe category of policy under consideration included family coverage, as definedin Ā§431:10A-103.Ā  Att. Gen. Op. 97-10.

 

Case Notes

 

Ā  Under this article and Ā§431:10A-105(2)(A)(ii), standard"incontestability clause" of contract precluded insurer from denyinginsured "total disability benefit" contracted for, notwithstandingthat HIV infection that caused the disability arguably "manifested"itself prior to policy's effective date of coverage.Ā  86 H. 262, 948 P.2d 1103.

 

Ā§431:10A-101Ā  Applications and exceptions.Ā This part shall apply to all policies of accident and health or sicknessinsurance delivered or issued for delivery in this State, except that nothingin this part shall apply to or affect:

(1)Ā  Any policy of workers' compensation insurance orany policy of vehicle or liability insurance with or without supplementarycoverage therein;

(2)Ā  Any policy or contract of reinsurance;

(3)Ā  Any blanket or group policy of insurance; or

(4)Ā  Life insurance, endowment, or annuity contracts,or contracts supplemental thereto which contain only such provisions relatingto accident and health or sickness insurance as:

(A)Ā  Provide additional benefits in case ofdeath, dismemberment, or loss of sight by accident; or

(B)Ā  Operate to safeguard such contractsagainst lapse, or to give a special surrender value, special benefit, or anannuity in the event that the insured or annuitant shall become totally andpermanently disabled, as defined by the contract or supplemental contract. [L1987, c 347, pt of Ā§2; am L 2002, c 155, Ā§49]