§431:10A-203  Standard provisions.  Everypolicy of group or blanket disability insurance shall contain in substance thefollowing provisions, or provisions which in the opinion of the commissionerare more favorable to the individuals insured, or at least as favorable to suchindividuals and more favorable to the policyholder.  No such policy of group orblanket disability insurance shall contain any provision relative to notice orproof of loss, or to the time for paying benefits, or to the time within whichsuit may be brought upon the policy, which in the opinion of the commissioneris less favorable to the individuals insured than would be permitted by thestandard provisions required for individual accident and health or sicknessinsurance policies.

(1)  Representations.  There shall be a provisionthat:

(A)  All statements, made by the policyholderor by the individuals insured, shall be deemed to be representations and notwarranties;

(B)  No statement, made in the application bythe policyholder, shall be used in any contest unless a copy of theapplication, if any, of the policyholder shall be attached to the policy whenissued;

(C)  No statement made by any individualinsured shall be used in any contest unless a copy of the instrument containingthe statement is or has been furnished to such individual or to theindividual's beneficiary, if any; and

(D)  A misrepresentation, unless it is madewith actual intent to deceive or unless it materially affects either theacceptance of the risk or the hazard assumed by the insurer, shall not preventa recovery on the policy.

(2)  Certificates.  There shall be a provision thatthe insurer shall issue to the policyholder for delivery to each insuredemployee or member, an individual certificate setting forth in summary form astatement of the essential features of the insurance coverage, and to whom thebenefits are payable.  If family members are insured, only one certificate needbe issued for each family.  This paragraph shall not apply to blanket disabilityinsurance policies.

(3)  Additional insureds.  There shall be a provisionthat to the group originally insured may be added, from time to time, eligiblenew employees, members, or dependents, as the case may be, in accordance withthe terms of the policy.

(4)  Age limitations.  There shall be a provisionspecifying:

(A)  The ages, if any, to which the insuranceprovided shall be limited;

(B)  The ages, if any, for which additionalrestrictions are placed on benefits; and

(C)  The additional restrictions placed on thebenefits at such ages.

(5)  Payment of premiums.  There shall be a provisionthat all premiums due under the policy shall be remitted by the employer oremployers of the persons insured, by the policyholder or by some otherdesignated person acting on behalf of the association or group insured, to theinsurer on or before the due date thereof within such grace period as may bespecified therein. [L 1987, c 347, pt of §2; am L 1989, c 195, §24; am L 2002,c 155, §61]