CHAPTER 4. Standard Provisions in Disability Policies [10270. - 10402.1.]
Chapter 4 enacted by Stats. 1935, Ch. 145.
§§ 10270–10402.1 · 120 sections
ARTICLE 1. Scope of Chapter and Definitions §§ 10270–10279 · 42 sections
- § 10270 (a) This chapter shall not apply to workers’ compensation insurance, any policy of liability insurance with or without supplementary coverage, or any policy or…
- § 10270.1 (a) As used in this section: (1) “Institution” means any school, college or other institution of learning or the principal or head thereof. “Camp” means one or…
- § 10270.2 (a) Blanket insurance is that form of insurance providing coverage for specified circumstances and insuring by description all or nearly all persons within a…
- § 10270.2.5 (a) In addition to the permitted types of blanket insurance issued to entities described in Section 10270.2, the commissioner may, in his or her discretion,…
- § 10270.3 (a) A blanket disability policy of a type permitted under paragraph (2) or (5) of subdivision (a) of Section 10270.2 may include either a coordination of…
- § 10270.4 Any disability insurer may issue policies of group disability insurance and family expense disability insurance as defined in this article but shall not issue…
- § 10270.5 Group disability insurance is that form of disability insurance which conforms to all of the following conditions: (a) Written under a master policy, issued to…
- § 10270.505 Another permitted form of group disability insurance is that which conforms to all of the following conditions. (1) Covering debtors who are or become…
- § 10270.507 Except as provided in Section 10195 with respect to regulation of group Medicare supplemental insurance, and provisions of law regulating group long-term care…
- § 10270.51 The state and any political subdivisions thereof and any municipality, may provide for the type of insurance set forth in Section 10270.5 of this code the same…
- § 10270.55 (a) With respect to a policy issued to a corporation, copartnership or individual employer eligible for group insurance pursuant to Section 10270.5, the term…
- § 10270.57 Another form of group disability insurance is that form of disability insurance conforming to the following conditions: (a) Written under a master policy…
- § 10270.6 Every group disability master policy shall contain the following provisions: (a) A provision that the policy, the application of the policyholder, and the…
- § 10270.63 An individual certificate shall be individualized, except that in the case of an individual certificate under a group policy which requires no regular…
- § 10270.65 If hereafter any dividend is paid or any premium refunded under any policy of group disability insurance heretofore or hereafter issued, the excess, if any, of…
- § 10270.7 Family expense disability insurance is that form of disability insurance insuring more than one person and issued to the head of a family or his spouse…
- § 10270.8 Family expense disability policies shall also contain the following provisions: (a) A provision that the policy and the application, if any, of the head of the…
- § 10270.9 No group disability policy shall be issued or delivered in this state nor, except as otherwise provided in Sections 10270.91 and 10270.98, shall an insurer…
- § 10270.91 An insurer is permitted to provide group disability coverage prior to the approval of the form of the policy if all of the conditions of (a) are met prior…
- § 10270.92 The commissioner may suspend or revoke the permission granted any insurer in Section 10270.91 if, after notice and hearing in accordance with Chapter 5 of Part…
- § 10270.93 No family expense disability policy shall be issued or delivered in this State unless a copy of the form thereof is filed with the commissioner and approved by…
- § 10270.94 The commissioner shall promulgate forms of provisions which incorporate in substance the applicable provisions set forth in Articles 4 (commencing with Section…
- § 10270.95 Without affecting the applicability or degree of applicability of other sections of this chapter, it is hereby specified that the provisions of Sections 10321,…
- § 10270.97 Selected group disability insurance is that form of disability insurance conforming to the following conditions: (a) Written under individual policies (1)…
- § 10270.98 Group disability policies may provide, among other things, that the benefits payable thereunder are subject to reduction if the individual insured has any…
- § 10270.99 The term “individual policies or contracts,” as used in the first paragraph of Section 10270.98, does not include selected group disability policies or…
- § 10271 (a) Except as set forth in this section and in Sections 10271.1, 10292, and 10295 to 10295.19, inclusive, this chapter does not apply to, or in any way affect,…
- § 10271.1 (a) (1) Supplemental benefits that operate to safeguard life insurance contracts against lapse are defined as a waiver of premium benefit or a waiver of…
- § 10272 The term “indemnity,” as used in this chapter means benefits promised.
- § 10273 The term “noncancelable policy” or “noncancelable and guaranteed renewable policy” as used in this chapter means a policy which the insured has the right to…
- § 10273.3 The term “guaranteed renewable policy” as used in this chapter (commencing with Section 10270) means a policy which the insured has the right to continue in…
- § 10273.4 All disability insurers writing, issuing, or administering group health benefit plans shall make all of these health benefit plans renewable with respect to…
- § 10273.5 No person shall cause or permit to be issued, circulated or used any representation that a policy defined in Section 10273.3 is “non-can,” noncancelable (not…
- § 10273.6 All individual health benefit plans shall be renewable with respect to all eligible individuals or dependents at the option of the individual except as…
- § 10273.7 (a) A policyholder, certificate holder, or other insured who alleges that a policy or coverage has been or will be canceled, rescinded, or not renewed in…
- § 10274 The term “endorsement” as used in this chapter means any amendment, change, limitation, alteration or restriction of the printed text of a policy by a rider…
- § 10275 The term “policy of accident and sickness insurance” as used in this chapter includes any policy or contract covering the kind or kinds of insurance described…
- § 10276 Every individual accident and health policy or contract, except single premium nonrenewable policies or contracts, issued for delivery in this state on or…
- § 10277 (a) A group health insurance policy that provides that coverage of a dependent child of an employee or other member of the covered group shall terminate upon…
- § 10278 (a) An individual health insurance policy that provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent…
- § 10278.1 (a) An individual health insurance policy issued, amended, or renewed on or after January 1, 2023, that provides dependent coverage shall make dependent…
- § 10279 (a) Every disability insurer that provides group or individual policies of disability, or both, that provides, operates, or contracts for, telephone medical…
ARTICLE 2. Approval of Commissioner §§ 10290–10293 · 6 sections
- § 10290 A disability policy shall not be issued or delivered to any person in this state until both of the following conditions are met: (a) A copy of the form thereof…
- § 10291 If the commissioner notifies the insurer, in writing, that the filed form does not comply with the requirements of law, specifying the reasons for his opinion,…
- § 10291.5 (a) The purpose of this section is to achieve both of the following: (1) Prevent, in respect to disability insurance, fraud, unfair trade practices, and…
- § 10291.6 Insofar as the reduction of any original benefit on account of age of the insured is concerned, a noncancellable policy may be approved if such reduction does…
- § 10292 (a) A supplemental benefit described in subdivision (a) of Section 10271 shall not be delivered or issued for delivery to any person in this state until a copy…
- § 10293 (a) The commissioner shall, after notice and hearing, withdraw approval of an individual or mass-marketed policy of disability insurance if after consideration…
ARTICLE 2.1. Accelerated Death Benefits §§ 10295–10295.19 · 20 sections
- § 10295 (a) An accelerated death benefit, as described in this section, shall not be offered, sold, issued, or marketed as health, accident, or long-term care…
- § 10295.1 (a) An accelerated death benefit as defined in paragraph (1) of subdivision (b) of Section 10295 shall comply with, and shall explain all of, the following:…
- § 10295.2 A life insurance contract with an accelerated death benefit or an accelerated death benefit in the form of a rider or endorsement shall be submitted for the…
- § 10295.3 (a) A written disclosure, as set forth below, shall be included with the filing for the commissioner’s approval, and shall be given to each applicant. The same…
- § 10295.4 An insurer shall file with the commissioner an actuarial memorandum prepared, dated, and signed by a member of the American Academy of Actuaries that includes…
- § 10295.5 (a) Applications, if any, or forms supporting an application, if any, for accelerated death benefits shall contain clear, unambiguous, short, and simple…
- § 10295.6 (a) When a policyholder or certificate holder requests an acceleration of death benefits, the insurer shall send a statement to the policyholder or certificate…
- § 10295.7 (a) The insurer may require a premium charge or cost of insurance charge for the accelerated death benefit. This charge shall be based on sound actuarial…
- § 10295.8 (a) An applicant for an accelerated death benefit shall have the right to return the accelerated death benefit policy or certificate by first-class United…
- § 10295.9 (a) Application forms for accelerated death benefits shall include a question designed to elicit information as to whether the accelerated death benefit is…
- § 10295.10 An insurer may not: (a) Cancel, nonrenew, or otherwise terminate an accelerated death benefit on the grounds of the age or the deterioration of the mental or…
- § 10295.11 (a) An accelerated death benefit shall not be advertised or marketed as long-term care insurance, nursing home insurance, or home care insurance. Any…
- § 10295.12 (a) Insurers shall ensure that agents offering, marketing, or selling accelerated death benefits on their behalf are able to describe the differences between…
- § 10295.13 In addition to other unfair trade practices described in this code, the following acts and practices in the sale of insurance under this article are…
- § 10295.14 (a) Accelerated death benefits shall comply with the provisions in Sections 10113.71 and 10113.72. (b) Every insurer offering term life insurance with…
- § 10295.15 (a) Except at the request of the policyholder or contractholder, all accelerated death benefit provisions or supplemental contracts shall be renewable for the…
- § 10295.16 Termination of an accelerated death benefit shall not prejudice the payment of benefits for any qualifying event that occurred while the accelerated death…
- § 10295.17 An insurer that fails to conform to the requirements provided under this article shall be subject to Article 6.5 (commencing with Section 790) of Chapter 1 of…
- § 10295.18 Accelerated death benefits shall not limit or exclude coverage by type of illness, treatment, medical condition, or accident, except under the circumstances…
- § 10295.19 A policy, certificate, rider, or endorsement shall include a provision giving the policyholder or certificate holder the right to appeal to the insurer a…
ARTICLE 3. Policy Form Generally—Uniform Provisions §§ 10320–10328 · 10 sections
- § 10320 No policy of accident and sickness insurance shall be delivered or issued for delivery to any person in this state unless all of the following apply: (a) The…
- § 10321 After issuance a disability policy shall not be amended, changed, limited, altered, or restricted by any means other than rider upon a separate piece of paper.
- § 10322 If any disability policy is issued by an insurer domiciled in this State for delivery to a person residing in another state, and if the official having…
- § 10323 If any provision set forth in Article 4a or 5a of this chapter is in whole or in part inapplicable to or inconsistent with the coverage provided by a…
- § 10324 The provisions which are the subject of Article 4a or 5a of this chapter or any corresponding provisions which are used in lieu thereof in accordance with such…
- § 10325 The word “insured,” as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making…
- § 10326 Any disability policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this State, may contain any provision which is not…
- § 10326.5 Any disability policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the…
- § 10327 The commissioner may make such reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as…
- § 10328 No policy provision which is not subject to Article 4a or 5a of this chapter shall make a policy or any portion thereof less favorable in any respect to the…
ARTICLE 4. Compulsory Standard Provisions—Uniform Provisions §§ 10350–10354 · 16 sections
- § 10350 Except as provided in Section 10323, each disability policy delivered or issued for delivery to any person in this State shall contain the provisions specified…
- § 10350.1 A disability policy shall contain a provision which shall be in the form set forth herein. Entire Contract; Changes: This policy, including the endorsements…
- § 10350.2 A disability policy shall contain a provision that shall be in one of the two forms set forth in this section. Policies other than noncancellable policies…
- § 10350.3 A disability policy shall contain a provision which shall be in one of the two forms set forth herein. Form A shall be used in a policy in which the insurer…
- § 10350.4 A disability policy shall contain a provision which shall be in the form set forth herein. The last sentence of such provision may be omitted from a…
- § 10350.5 A disability policy shall contain a provision which shall be in one of the two forms set forth herein. Form A may be used in any policy. Form B may be used by…
- § 10350.6 A disability policy shall contain a provision which shall be in the form set forth herein. Claim Forms: The insurer, upon receipt of a notice of claim, will…
- § 10350.7 A disability policy shall contain a provision which shall be in the form set forth herein. Proofs of Loss: Written proof of loss must be furnished to the…
- § 10350.8 A disability policy shall contain a provision which shall be in the form set forth herein. In the blank of such provision will be inserted the period for…
- § 10350.9 A disability policy shall contain a provision which shall include the following first paragraph and which may, at the option of the insurer, include either or…
- § 10350.10 A disability policy shall contain a provision which shall be in the form set forth herein. Physical Examinations and Autopsy: The insurer at its own expense…
- § 10350.11 A disability policy shall contain a provision which shall be in the form set forth herein. Legal Actions: No action at law or in equity shall be brought to…
- § 10350.12 A disability policy shall contain a provision which shall be in the form set forth herein. At the insurer’s option, the clause of such provision which precedes…
- § 10351 Each policy of disability insurance issued or renewed on or after the effective date of this section, shall provide, where feasible, that benefits for…
- § 10353 (a) Every policy of disability insurance issued, amended, or renewed on or after January 1, 1992, that offers coverage for perinatal services shall contain a…
- § 10354 (a) (1) Every policy of disability insurance issued, amended, or renewed on or after January 1, 1994, that offers coverage for perinatal services shall contain…
ARTICLE 5. Optional Standard Provisions and Special Provisions—Uniform Provisions §§ 10369.1–10369.12 · 12 sections
- § 10369.1 Except as provided in Section 10323, no disability policy delivered or issued for delivery to any person in this State shall contain provisions respecting the…
- § 10369.2 A disability policy may contain a provision in the form set forth herein. Change of Occupation: If the insured be injured or contract sickness after having…
- § 10369.3 A disability policy may contain a provision in the form set forth herein. Misstatement of Age: If the age of the insured has been misstated, all amounts…
- § 10369.4 A disability policy may contain a provision which shall, at the option of the insurer, be in one of the two forms set forth herein. If Form A is used, there…
- § 10369.5 A disability policy may contain a provision in the form set forth in this section. If the provision also contains the provision set forth in Section 10369.6,…
- § 10369.6 A disability policy may contain a provision in the form set forth in this section. If the provision is included in a policy which also contains the provision…
- § 10369.7 A noncancellable disability policy may contain a provision in the form set forth herein. The insurer may, at its option, include in this provision a definition…
- § 10369.8 A disability policy may contain a provision in the form set forth herein. Unpaid Premium: Upon the payment of a claim under this policy, any premium then due…
- § 10369.9 A disability policy may contain a provision in the form set forth herein. Cancellation: The insurer may cancel this policy at any time by written notice…
- § 10369.10 A disability policy may contain a provision in the form set forth herein. Conformity With State Statutes: Any provision of this policy which, on its effective…
- § 10369.11 A disability policy may contain a provision in the form set forth herein. Illegal Occupation: The insurer shall not be liable for any loss to which a…
- § 10369.12 (a) A disability policy may contain a provision in the form set forth herein. Intoxicants and controlled substances: The insurer shall not be liable for any…
ARTICLE 6. Interpretation of Policy §§ 10380–10390 · 9 sections
- § 10380 The falsity of any statement in the application for any policy covered by this chapter shall not bar the right to recovery under the policy unless such false…
- § 10381 The following shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such disability policy: (a) The…
- § 10381.5 The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy…
- § 10382 No alteration of any written application for any disability policy shall be made by any person other than the applicant without his written consent except that…
- § 10383 If any disability policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be…
- § 10384 No insurer issuing or providing any policy of disability insurance covering hospital, medical, or surgical expenses shall engage in the practice of postclaims…
- § 10384.17 (a) A health insurer shall not rescind a health insurance policy, or limit any provisions of a health insurance policy, once an insured is covered under the…
- § 10385 Compensation of a person or entity employed by, or contracted with, a disability insurer shall not be based on, or related in any way to, the number of…
- § 10390 A policy delivered or issued for delivery to any person in this State in violation of this chapter shall be held valid but shall be construed as provided in…
ARTICLE 7. Exemption § 10395 · 1 section
- § 10395 The provisions of Sections 800, 801, 802, 803, and 804 shall not apply to disability insurance.
ARTICLE 8. Penalties §§ 10400–10402.1 · 4 sections
- § 10400 Any person willfully violating any provision of this chapter or order of the commissioner made in accordance therewith shall forfeit to the people of this…
- § 10401 Any incorporated insurer admitted for disability insurance and any agent of such insurer, that makes or permits any discrimination between insureds of the same…
- § 10402 Any person who, without the prior authorization of an insurer or plan solicits a provider to enter into a contract for alternative rates under Section 10133 or…
- § 10402.1 An insurer or plan which accepts or ratifies a contract for alternative rates known by it to have been executed by a provider prior to the insurer’s or plan’s…