Procedure or Language Change

Transcription

1 The following list indicates important policy language changes or other procedures required in states for this product. Please access for copies of miscellaneous notices and outlines of coverage, if applicable. Alabama Alaska Arizona Arkansas California required complaint notice Language added to the policy face page. Definition of Total Disability - Removed regular care of a physician. Exclusions From Coverage - Assault and violent disorder are removed from the list of causes of excluded disabilities. Loss of professional/occupational license and disability while confined to a correctional institution also removed. Includes a new definition of War. Pre-Existing Conditions We will pay benefits only if the policy has been continuously in force for 24 consecutive months. Time Limit on Certain Defenses and Reinstatement 2-yr period cannot (re)start from reinstatement date / reinstatement Colorado Written Proof of Total Disability As of 8/08, includes state required language regarding right to trial by jury for disputed claims. Time Limit on Certain Defenses Provision revised by endorsement/rider. Connecticut Exclusions From Coverage - Assault and violent disorder are removed from the list of causes of excluded disabilities. Exclusions From Coverage - Participating and riot are defined in the provision. Pre-existing Conditions - Added: Denial of any claim based on disability contributed to or caused by a pre-existing condition is subject to the Time Limit On Certain Defenses provision, below. Replacement Notices 10033(5/06) and 7640(8/95)AR - required with application if applicable. Return signed forms to home office with Outline of Coverage (7/93) required at time of app. Replacement Notice 6457(5/05)CO - Other Insurance Application Sup., 12290(5/05)CO, required with base app, DIAPP(5/05)CO, and FPO app, 11357(5/05)CO. Send signed form to HO with app (02/2014) 1 of 8

2 Connecticut, continued Time Limit on Certain Defenses - References to fraudulent misstatements removed. Delaware District of Columbia Florida Georgia Hawaii Idaho Total Disability - Removed You do not perform any work for the Business from the definition. Benefit for Total Disability - Added statements removed from definition of Total Disability. Legal Action - Legal action may not be brought against Us after the applicable statute of limitations (3 years in generic). Exclusion/Limitation Endorsements - Statutes provide specific language and time restrictions for Exclusions and Limitation Endorsements due to breast cancer/tumors. Exclusions Assault deleted; violent disorder changed to act of civil disobedience. Claim Forms - Send within 10 (not 15) business days. Time of Payment - Language outlines specific notice and payment procedures if benefit payments do not begin 15 days after written proof of loss and 15 days after receipt of additionally requested documents. Requires interest payment (18% per annum) if benefits not paid within 15 days after all required documentation/information is received. Written Proof of Total Disability - Written proof must be given within 15 months (not one year). Insurance With Other Insurers - Provision removed. Exclusions From Coverage - Language for suspension, revocation or surrender of professional license removed. Exclusions From Coverage - Assault and violent disorder and riot are removed from the list of causes of excluded disabilities (02/2014) 2 of 8 Replacement Notice 9919(11/00)FL - required with application if applicable. Return signed form to home office with Outline of Coverage (11/03)GA required at time of app. Outline of Coverage (11/03)ID and receipt, 10127(6/01)ID required at the time of app. Send signed receipt to the Home Office with the app.

3 Idaho, continued Pre-existing Conditions - Six-month look back period rather than 365 days. Exclusion/Limitation Endorsements - Cannot exclude or limit for hazardous sports or activities. Application must be declined if hazardous activity is a concern. Illinois Time of Payment - Payments shall begin within 30 days from receipt of satisfactory proof of loss. If after 30 days, interest at 9% must be paid. Indiana Definition of Sickness - Your illness or disease which causes You to become Disabled. Exclusions From Coverage - (added no. 6) Any Disability where the policy was not in force at the time You became Disabled. Iowa Total Disability - Definition does not include regular care of a physician. Exclusions from Coverage - Disability that begins while incarcerated. Kansas Time Limit On Certain Defenses - Language clarification that contestable period is measured from reinstatement date only if an application for reinstatement was required. Cancellation By Owner provision added - Under this required provision, policy terminates on date owner s written request is received by home office, or on the date requested in the notice. Prompt premium refund using pro rata method. Policy Termination provision - Added item for cancellation by owner under the above provision. Legal Action - Five years (rather than 3) allowed for legal action. Kentucky Written Notice of Claim - We must receive notice within 60 days after loss (generic 30 days). Louisiana Total Disability - Removed You do not perform any work for the Business from the definition. Benefit for Total Disability - Inserted those statements removed from definition of Total Disability (above). Conformity With Statutes replaced with Extension Of Time Limits provision - time limitations are extended to the minimum period permitted by law. Replacement Notice 10033(5/06) - Policy fee statement cannot be displayed on Data Pages or in Illustrations. (Fee is still incorporated into the base policy premium, however.) Replacement Notice 6462(1/91)KY (02/2014) 3 of 8

4 Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Definition of Sickness - The Illness of an insured person. Pre-existing Conditions - Disabilities not 12 months, measured from the Effective Date. Exclusions From Coverage- Assault and violent disorder and riot are removed from the list of causes of excluded disabilities. Time Limit on Certain Defenses - Revised to separate and add new provision for Time Limit On Certain Defenses After Reinstatement. Six month period for requesting reinstatement removed (no limitation on period to request reinstatement). Pre-existing Conditions language added to face page of policy. Sickness Definition revised to is first diagnosed or treated Exclusions From Coverage - Assault removed form exclusions. Pre-existing Conditions - Disabilities not 24 months, measured from the Eff. Date. Time of Payment - Benefits not payable periodically will be paid within 35 days after satisfactory proof. Outline of Coverage (11/04)ME and receipt 12404(11/04)ME required at time of app. Send signed receipt to the HO with app. Replacement Notice 12410(11/04)ME - required with application if applicable. Return signed form to home office with Replacement Notice 9948(3/01)MA - Guaranty Association Notice 7127(11/10)MN must be provided at time of app. Delivery Receipt 8770(11/10)MN must be signed by producer and sent to the HO with the app. Montana Nebraska Gender neutral rates only. All references to Gender neutral rates. gender are removed from policy. Outline of Coverage (11/06)MT Physician includes osteopaths, chiropractors, required at time of app. optometrists, chiropodists and psychologists. Pre-existing Conditions - Disabilities 12 months, measured from the Effective Date. Exclusions from Coverage - Exclusion 13659(02/2014) 4 of 8

5 Nebraska, continued Nevada New Hampshire New Jersey New Mexico North Carolina North Dakota while confined to a penal or correctional institution removed. Conformity With and Federal Laws (replaces generic Conformity With Statutes provision) Any provision of the policy that conflicts with law of federal government or state in which insured resides is amended to conform to the minimum requirements of such law. Reinstatement - Administratively reinstated policy covers Disability due to injury sustained or sickness that began on or after the Reinstatement Date. Refund Upon Cancellation provision added: cancellation effective upon receipt of written notice from owner/insured or on later date specified in notice; premium refund within 30 days to owner. Sickness Definition - Expanded to state sickness or disease commencing more than 30 days after the effective date and which is not excluded under the pre-existing condition limitation. Exclusions from Coverage - Exclusion while confined to a penal or correctional institution removed. Pre-existing Conditions - Disabilities not 24 months, measured from the Eff. Date. Definition of Regular Care added. Pre-existing Conditions - A Pre-x condition not specifically excluded is excluded for only 12 months, measured from the Effective Date. Written Proof of Loss - Must be provided to the insurer within 180 days of loss (generic 90 days). Exclusions from Coverage - Exclusion while confined to a penal or correctional institution removed. Pre-existing Conditions - A Pre-x condition not specifically excluded is excluded for only 24 months, measured from the Effective Date. Pre-existing Condition - Reasonably 13659(02/2014) 5 of 8 Outline of Coverage (11/03) required at time of app. Outline of Coverage (11/03)NH and receipt 10034(2/01)NH required at time of app. Send signed receipt to the HO with app. Replacement Notice 10033(5/06) - Producer Information Report 11302(10/05)NJ used with base app. Replacement Notice 9949(12/00)NJ -

6 Ohio Oklahoma Right to Return - Refund premium within 30 days of cancellation or we will pay interest on amount to be refunded. Exclusions From Coverage - Declared or undeclared war or act of war while serving in military or auxiliary unit attached to military service. Time Limit on Certain Defenses and Reinstatement - 2-yr period cannot (re)start from reinstatement date / reinstatement Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Sickness - Definition revised to is first diagnosed or treated Exclusions From Coverage - War exclusion language modified. prudent person language is removed. Exclusions From Coverage - Language for suspension, revocation or surrender of professional license not allowed. Exclusions From Coverage - Exclusion for disability caused while confined to a penal or correctional institution removed. Legal Action - Six years (rather than 3) allowed for legal action. Misstatements - Reference to gender removed. Time Limit on Certain Defenses and Reinstatement - Language regarding reinstatement after the 2-yr period removed Reinstatement - If an application is required for reinstatement a new period for contesting the statements in the Replacement Notice 6836(4/01)PA - Producer Information Report 11302(5/05)RI used with base app. Outline of Coverage (11/03)SD and receipt 10011(12/00)SD, required at time of app. Send signed receipt to the HO with app. Outline of Coverage (11/03)TX, and receipt 4771(2/93)TX, required at time of app. Send signed receipt to HO with app (02/2014) 6 of 8

7 Texas, continued application for reinstatement will apply to the reinstated policy (02/2014) 7 of 8 Notice not required if policy being replaced was part of association group. Utah Replacement Notice 10122(5/06)UT - Vermont Exclusions from Coverage - Removed 1) act incident to war, substantial armed conflict of a military nature, ; 2) assault and violent disorder ; and 3) confinement to penal/correctional institution. Virginia Total Disability - Gainful occupation - added: "for which you are or may become qualified by reason of education, training, or experience." Exclusions from Coverage - Removed 1) Substantial armed conflict with organized forces of a military nature from War exclusion; and 2) confined to a penal/correctional institution. Time Limit on Certain Defenses - (1) Only applies to misstatements in initial application, not in the reinstatement (2) A claim cannot be denied on the basis of a pre-existing condition where the disability started after one year from the effective date, unless the condition is specifically excluded or there is fraud. Cancellation By The Insured provision added - Under this required provision, policy terminates on date insured s written request is received by home office, or on the date requested in the notice. Prompt premium refund using pro rata method. Washington Total Disability - Definition does not include regular care of a physician. Exclusions from Coverage - Removed - Substantial armed conflict with organized forces of a military nature from War exclusion. Misstatements - If there was a misstatement in age, we will pay the amount of any underpayment. We may also charge the amount of any overpayment against any payment due under the policy. Interest may be charged. Replacement Notice 10013(12/00), if applicable. Send signed form to HO with app.

8 West Virginia Wisconsin Wyoming Pre-existing Conditions language added to face page of policy. Pre-existing Conditions - Disabilities not 12 months, measured from the Effective Date. Time Limit on Certain Defenses and Reinstatement - 2-yr period cannot (re)start from reinstatement date / reinstatement Written Notice of Claim - We must receive notice within 60 days after loss (generic is 30 days). Outline of Coverage (11/03)WV and receipt 10018(12/00)WV must be provided at the time of app. Send signed receipt to the HO with app. Outline of Coverage (11/03) required at the time of app. Replacement Notice 6402(11/90)WI (02/2014) 8 of 8