§431:10A-203  Standard provisions.  Every
policy of group or blanket disability insurance shall contain in substance the
following provisions, or provisions which in the opinion of the commissioner
are more favorable to the individuals insured, or at least as favorable to such
individuals and more favorable to the policyholder.  No such policy of group or
blanket disability insurance shall contain any provision relative to notice or
proof of loss, or to the time for paying benefits, or to the time within which
suit may be brought upon the policy, which in the opinion of the commissioner
is less favorable to the individuals insured than would be permitted by the
standard provisions required for individual accident and health or sickness
insurance policies.



(1)  Representations.  There shall be a provision
that:



(A)  All statements, made by the policyholder
or by the individuals insured, shall be deemed to be representations and not
warranties;



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



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



(D)  A misrepresentation, unless it is made
with actual intent to deceive or unless it materially affects either the
acceptance of the risk or the hazard assumed by the insurer, shall not prevent
a recovery on the policy.



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



(3)  Additional insureds.  There shall be a provision
that to the group originally insured may be added, from time to time, eligible
new employees, members, or dependents, as the case may be, in accordance with
the terms of the policy.



(4)  Age limitations.  There shall be a provision
specifying:



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



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



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



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