§431:10A-106  Optional provisions.  Except
as provided in section 431:10A-107, no policy of accident and health or
sickness insurance delivered or issued for delivery to any person in this State
shall contain the provisions set forth below unless the provisions are in the
words in which they appear below; provided that the insurer may substitute
corresponding provisions of different wording approved by the commissioner that
are in each instance not less favorable in any respect to the insured or the
beneficiary.  Such provisions are optional provisions.  Any such provision
contained in the policy shall be preceded individually by the specified caption
or, at the option of the insurer, by such appropriate individual or group
captions or subcaptions as the commissioner may approve.  The provisions are as
follows:



(1)  "Change of
Occupation:  If the insured is injured or contracts sickness after having
changed occupations to one classified by the insurer as more hazardous than
that stated in this policy or while doing for compensation anything pertaining
to an occupation so classified, the insurer will pay only such portion of the
indemnities provided in this policy as the premium paid would have purchased at
the rates and within the limits fixed by the insurer for the more hazardous
occupation.  If the insured's occupation changes to one classified by the
insurer as less hazardous than that stated in this policy, the insurer, upon
receipt of proof of such change of occupation, will reduce the premium rate
accordingly, and will return the excess pro rata unearned premium from the date
of change of occupation or from the policy anniversary date immediately
preceding receipt of such proof, whichever is the more recent.  In applying
this provision, the classification of occupational risk and the premium shall
be such as have been last filed by the insurer prior to the occurrence of the
loss for which the insurer is liable or prior to date of proof of change in
occupation with the state official having supervision of insurance in the state
where the insured resided at the time this policy was issued; but if such
filing was not required, then the classification of occupational risk and the
premium rates shall be those last made effective by the insurer in such state
prior to the occurrence of the loss or prior to the date of proof of change in
occupation."



(2)  "Misstatement of Age:  If the age of the
insured has been misstated, all amounts payable under this policy shall be such
as the premium paid would have purchased at the correct age."



(3)  Other insurance in this insurer shall be in one
of the following forms:



(A)  "Other Insurance in This Insurer:  If
an accident and health or sickness policy or policies previously issued by the
insurer to the insured be in force concurrently herewith, making the aggregate
indemnity for (insert type of coverage or coverages) in excess of $ (insert
maximum limit of indemnity or indemnities) the excess insurance shall be void
and all premiums paid for such excess shall be returned to the insured or to
the insured's estate."; or



(B)  "Other Insurance in This Insurer: 
Insurance effective at any one time on the insured under a like policy or
policies in this insurer is limited to the one such policy elected by the
insured, the insured's beneficiary, or the insured's estate, as the case may
be, and the insurer will return all premiums paid for all other such
policies."



(4)  Insurance with other insurers.  Either or both of
the following forms shall be used:



(A)  (i)  "Insurance with Other Insurers:  If
there be other valid coverage, not with this insurer, providing benefits for
the same loss on a provision of service basis or on an expense incurred basis
and of which this insurer has not been given written notice prior to the
occurrence or commencement of loss, the only liability under any expense
incurred coverage of this policy shall be for such proportion of the loss as
the amount which would otherwise have been payable hereunder plus the total of
the like amounts under all such other valid coverages for the same loss of
which this insurer had notice bears to the total like amounts under all valid
coverages for such loss, and for the return of such portion of the premiums
paid as shall exceed the pro rata portion for the amount so determined.  For
the purpose of applying this provision when other coverage is on a provision of
service basis, the like amount of such other coverage shall be taken as the
amount which the services rendered would have cost in the absence of such
coverage."



(ii)  "Insurance with Other Insurers:  If
there be other valid coverage, not with this insurer, providing benefits for
the same loss on other than an expense incurred basis and of which this insurer
has not been given written notice prior to the occurrence or commencement of
loss, the only liability for such benefits under this policy shall be for such
proportion of the indemnities otherwise provided hereunder for such loss as the
like indemnities of which the insurer had notice (including the indemnities under
this policy) bear to the total amount of all the indemnities for such loss, and
for the return of such portion of the premium paid as shall exceed the pro rata
portion for the indemnities thus determined."



(B)  If the provision set forth in subparagraph
(A)(i) is included in a policy that also contains the provision set forth in
subparagraph (A)(ii), there shall be added to the caption of the subparagraph
(A)(i) provision the phrase, "expense incurred benefits".



(C)  The insurer may, at its option, include in
the provision set forth in subparagraph (A)(i) a definition of other valid
coverage, approved as to form by the commissioner, which definition shall be
limited in subject matter to coverage provided by organizations subject to
regulation by insurance law or by insurance authorities of this State or any
other state or territory of the United States or any province of Canada, and by
hospital or medical service organizations, and to any other coverage the
inclusion of which may be approved by the commissioner.  In the absence of such
definition the term shall not include group insurance, automobile medical
payment insurance, or coverage provided by hospital or medical service
organizations, union welfare plans, or employer or employee benefit organizations. 
For the purpose of applying the provision set forth in subparagraph (A)(i) with
respect to any insured, any amount of benefit provided for such insured
pursuant to any compulsory benefit statute (including any workers' compensation
or employers' liability statute), whether provided by a governmental agency or
otherwise, shall in all cases be deemed to be other valid coverage of which the
insurer has had notice.  In applying the provision set forth in subparagraph
(A)(i), no third party liability coverage shall be included as other valid
coverage.



(D)  If the provision set forth in subparagraph
(A)(ii) is included in a policy that also contains the provision set forth in
subparagraph (A)(i), there shall be added to the caption of the subparagraph
(A)(ii) provision the phrase, "other benefits".



(E)  The insurer may, at its option, include in
the provision set forth in subparagraph (A)(ii) a definition of other valid
coverage, approved as to form by the commissioner, which definition shall be
limited in subject matter to coverage provided by organizations subject to
regulation by insurance law or by insurance authorities of this State or any
other state or territory of the United States or any province of Canada, and to
any other coverage the inclusion of which may be approved by the commissioner. 
In the absence of such definition the term shall not include group insurance,
or benefits provided by union welfare plans or employer or employee benefit
organizations.  For the purpose of applying the provision set forth in
subparagraph (A)(ii) with respect to any insured, any amount of benefit
provided for such insured pursuant to any compulsory benefit statute (including
any workers' compensation or employers' liability statute), whether provided by
a governmental agency or otherwise, shall in all cases be deemed to be other
valid coverage of which the insurer has had notice.  In applying the provision
set forth in subparagraph (A)(ii), no third party liability coverage shall be
included as other valid coverage.



(5)  (A)  "Relation of Earnings to Insurance: 
If the total monthly amount of loss of time benefits promised for the same loss
under all valid loss of time coverage upon the insured, whether payable on a
weekly or monthly basis, shall exceed the monthly earnings of the insured at
the time disability commenced or the insured's average monthly earnings for the
period of two years immediately preceding a disability for which claim is made,
whichever is the greater, the insurer will be liable only for such proportionate
amount of such benefits under this policy as the amount of such monthly
earnings or such average monthly earnings of the insured bears to the total
amount of monthly benefits for the same loss under all such coverage upon the
insured at the time such disability commences and for the return of such part
of the premiums paid during such two years as shall exceed the pro rata amount
of the premiums for the benefits actually paid hereunder; but this shall not
operate to reduce the total monthly amount of benefits payable under all such
coverage upon the insured below the sum of $200 or the sum of the monthly
benefits specified in such coverages, whichever is the lesser, nor shall it
operate to reduce benefits other than those payable for loss of time."



(B)  The policy provision in subparagraph (A)
may be inserted only in a policy which the insured has the right to continue in
force, subject to its terms by the timely payment of premiums until at least
age fifty or, in the case of a policy issued after age forty-four, for at least
five years from its date of issue.



(C)  The insurer may, at its option, include in
the provision set forth in subparagraph (A) a definition of valid loss of time
coverage approved as to form by the commissioner, which definition shall be
limited in subject matter to coverage provided by governmental agencies or by
organizations subject to regulation by insurance law or by insurance
authorities of this State or any state, district, or territory of the United
States or any province of Canada, or to any other coverage the inclusion of
which may be approved by the commissioner or any combination of such
coverages.  In the absence of such definition such terms shall not include any
coverage provided for such insured pursuant to any compulsory benefit statute
(including any workers' compensation or employers' liability statute), or
benefits provided by union welfare plans or by employer or employee benefit
organizations.



(6)  "Unpaid Premium:  Upon the payment of a
claim under this policy, any premium then due and unpaid or covered by any note
or written order may be deducted therefrom."



(7)  "Cancellation:  The insurer may cancel this
policy at any time by written notice delivered to the insured, or mailed to the
insured's last address as shown by the records of the insurer, stating when,
not less than five days thereafter, such cancellation shall be effective; and
after the policy has been continued beyond its original term the insured may
cancel this policy at any time by written notice delivered or mailed to the
insurer, effective upon receipt or on such later date as may be specified in
such notice.  In the event of cancellation, the insurer will return promptly
the unearned portion of any premium paid.  If the insured cancels, the earned
premium shall be computed by the use of the short-rate table last filed with
the state official having supervision of insurance in the state where the
insured resided when the policy was issued.  If the insurer cancels, the earned
premium shall be computed pro rata.  Cancellation shall be without prejudice to
any claim originating prior to the effective date of cancellation."



(8)  "Conformity with State Statutes:  Any
provision of this policy which, on its effective date, is in conflict with the
statutes of the state in which the insured resides on such date is hereby
amended to conform to the minimum requirements of such statutes."



(9)  "Illegal Occupation:  The insurer shall not
be liable for any loss to which a contributing cause was the insured's commission
of or attempt to commit a felony or to which a contributing cause was the
insured's being engaged in an illegal occupation."



(10)  "Intoxicants and Narcotics:  The insurer
shall not be liable for any loss sustained or contracted in consequence of the
insured's being intoxicated or under the influence of any narcotic unless
administered on the advice of a physician." [L 1987, c 347, pt of §2; am L
2002, c 155, §53; am L 2004, c 122, §32]