4512. Accident and health and disability insurance certificates; compliance with rules and regulations. (a) No certificate or other evidence of any contract of accident insurance, disability income insurance, or health insurance or of any total and permanent disability insurance and no application or rider or endorsement for use in connection therewith shall be delivered or issued for delivery in this state unless it conforms with reasonable rules and regulations prescribed by the superintendent and contains a provision that the rights or obligations of the insured member under any such certificate or other evidence of such contract, or of any person rightfully claiming thereunder, shall be governed by the laws of this state. Pursuant to the foregoing provisions the superintendent shall have power, from time to time to make, alter and supersede reasonable rules and regulations prescribing the required, optional and prohibited provisions in such contracts, and such rules and regulations shall conform, as far as practicable, to the provisions of section three thousand two hundred fifteen of this chapter or of section three thousand two hundred sixteen of this chapter, whichever shall be applicable. Where the superintendent deems inapplicable, either in part or in their entirety, the provisions of the aforesaid sections, he may prescribe the portions, or a summary thereof, of the contract to be printed in the certificate issued to the member.
(b) Anything in this article to the contrary notwithstanding, each certificate of hospitalization expense benefits or surgical or medical expense benefits delivered or issued for delivery in this state to any member individually or as the head of a family shall:
(1) stipulate a premium determined on the basis of the age of the member, which premium shall be subject to change only if the premiums on all outstanding certificates in the same class are changed in accordance with the standards which shall have been established prior to the issuance of the certificate for the determination of the increase or decrease in the premiums and are on file with and approved by the superintendent,
(2) contain the following provisions under the caption "Incontestable and Guaranteed Renewable":
"After this certificate has been in force for a period of one year from the date of issue, it shall become incontestable as to the statements contained in the application and the member shall have the right to continue the same in force, subject to the timely payment of premiums and the conditions of the certificate relating to military service;" and
(3) in the case of such certificates written at issue age above sixty-five years, contain the following provision:
"No claim for benefits provided in this certificate shall be reduced or denied on the ground that a disease or physical condition had existed prior to the effective date of coverage of this certificate, except only such disease or physical condition which is specifically eliminated by rider, attached to this certificate, a copy which shall have been furnished to the member and its receipt evidenced by a signed amendment to the application for such certificate."
Last modified: February 3, 2019