Group master service contract: Required provisions. Every group master hospital or group medical or dental service contract issued shall contain the following provisions:
1. A provision that the contract, the application of the employer, or executive officer or trustee of any association or trustees, and the individual applications, if any, of the employees or members covered shall constitute the entire contract between the parties, and that all statements made by the employer, or the executive officer, or trustee or trustees, or by the individual employee or member shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense to a claim under the contract, unless it is contained in a written application.
2. A provision that the corporation will issue to the employer or to the executive officer or trustee of the association or to the trustees, for delivery to each of the employees or members who are covered under such contract, an individual certificate setting forth a statement as to the hospital or medical or dental service to which he is entitled.
3. A provision that to the group or class thereof originally covered shall be added from time to time all new employees of the employer or members of the association eligible to and applying for coverage in such group or class.
4. A statement that such contract is not in lieu of workmen’s compensation insurance.
5. Such provisions as may be promulgated by the Commissioner from time to time.
Last modified: February 27, 2006