Umbrella policies: Disclosure statement indicating whether policy includes uninsured or underinsured motorist coverage; form.
1. An insurer offering an umbrella policy to an individual shall obtain a signed disclosure statement from the individual indicating whether the umbrella policy includes uninsured or underinsured vehicle coverage.
2. The disclosure statement for an umbrella policy that includes uninsured or underinsured vehicle coverage must be on a form provided by the Commissioner or in substantially the following form:
¨ Your Umbrella Policy does provide coverage in excess of the limits of the uninsured/underinsured vehicle coverage in your primary auto insurance only if the requirements for the uninsured/underinsured vehicle coverage in your underlying auto insurance are maintained. Your uninsured/underinsured vehicle coverage provided by this umbrella policy is limited to $........ .
I understand and acknowledge the above disclosure.
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Insured Date
3. The disclosure statement for an umbrella policy that does not include uninsured or underinsured vehicle coverage must be on a form provided by the commissioner or in substantially the following form:
¨ Your Umbrella Liability Policy does not provide any uninsured/underinsured vehicle coverage.
I understand and acknowledge the above disclosure.
.................................................. ...............................
Insured Date
4. As used in this section, “umbrella policy” means a policy that protects a person against losses in excess of the underlying amount required to be covered by other policies.
Last modified: February 27, 2006