§ 27-8-5-2 — Requirements for issuance and delivery of policy

Indiana § 27-8-5-2

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 5: Accident and Sickness Insurance─Policy Provisions

Text

(a) No individual policy of accident and sickness
insurance shall be delivered or issued for delivery to any person in this
state unless it complies with each of the following:
(1) The entire money and other considerations for the policy are
expressed in the policy.
(2) The time at which the insurance takes effect and terminates is
expressed in the policy.
(3) The policy purports to insure only one (1) person, except that
a policy must insure, originally or by subsequent amendment,
upon the application of any member of a family who shall be
deemed the policyholder and who is at least eighteen (18) years
of age, any two (2) or more eligible members of that family,
including husband, wife, dependent children, or any children who
are less than twenty-six (26) years of age, and any other person
dependent upon the policyholder.
(4) The style, arrangement, and overall appearance of the policy
give no undue prominence to any portion of the text, and unless
every printed portion of the text of the policy and of any
endorsements or attached papers is plainly printed in lightface
type of a style in general use, the size of which shall be uniform
and not less than ten point with a lower-case unspaced alphabet
length not less than one hundred twenty point (the "text" shall
include all printed matter except the name and address of the
insurer, name or title of the policy, the brief description if any,
and captions and subcaptions).
(5) The exceptions and reductions of indemnity are set forth in the
policy and, except those which are set forth in section 3 of this
chapter, are printed, at the insurer's option, either included with
the benefit provision to which they apply, or under an appropriate
caption such as "EXCEPTIONS", or "EXCEPTIONS AND
REDUCTIONS", provided that if an exception or reduction
specifically applies only to a particular benefit of the policy, a
statement of such exception or reduction shall be included with
the benefit provision to which it applies.
(6) Each such form of the policy, including riders and
endorsements, shall be identified by a form number in the lower
left-hand corner of the first page of the policy.
(7) The policy contains no provision purporting to make any
portion of the charter, rules, constitution, or bylaws of the insurer
a part of the policy unless such portion is set forth in full in the
policy, except in the case of the incorporation of or reference to
a statement of rates or classification of risks, or short-rate table
filed with the commissioner.
(8) If an individual accident and sickness insurance policy or
hospital service plan contract or medical service plan contract
provides that hospital or medical expense coverage of a
dependent child terminates upon attainment of the limiting age for
dependent children specified in such policy or contract, the policy
or contract must also provide that attainment of such limiting age
does not operate to terminate the hospital and medical coverage
of such child while the child is and continues to be both:
(A) incapable of self-sustaining employment by reason of
mental, intellectual, or physical disability; and
(B) chiefly dependent upon the policyholder for support and
maintenance.
Proof of such incapacity and dependency must be furnished to the
insurer by the policyholder within thirty-one (31) days of the
child's attainment of the limiting age. The insurer may require at
reasonable intervals during the two (2) years following the child's
attainment of the limiting age subsequent proof of the child's
disability and dependency. After such two (2) year period, the
insurer may require subsequent proof not more than once each
year. The foregoing provision shall not require an insurer to
insure a dependent who is a child who has a mental, intellectual,
or physical disability where such dependent does not satisfy the
conditions of the policy provisions as may be stated in the policy
or contract required for coverage under the policy or contract to
take effect. In any such case the terms of the policy or contract
shall apply with regard to the coverage or exclusion from
coverage of such dependent. This subsection applies only to
policies or contracts delivered or issued for delivery in this state
more than one hundred twenty (120) days after August 18, 1969.
(b) If any policy is issued by an insurer domiciled in this state for
delivery to a person residing in another state, and if the official having
responsibility for the administration of the insurance laws of such other
state shall have advised the commissioner that any such policy is not
subject to approval or disapproval by such official, the commissioner
may by ruling require that such policy meet the standards set forth in
subsection (a) and in section 3 of this chapter.
(c) An insurer may issue a policy described in this section in
electronic or paper form. However, the insurer shall:
(1) inform the insured that the insured may request the policy in
paper form; and
(2) issue the policy in paper form upon the request of the insured.
Formerly: Acts 1953, c.15, s.169.2; Acts 1969, c.266, s.1; Acts
1973, P.L.275, SEC.3. As amended by Acts 1977, P.L.2, SEC.79;
P.L.23-1993, SEC.153; P.L.207-1999, SEC.3 and P.L.233-1999,
SEC.9; P.L.125-2005, SEC.2; P.L.99-2007, SEC.192; P.L.218-2007,
SEC.45; P.L.160-2011, SEC.18; P.L.117-2015, SEC.37; P.L.136-2018,
SEC.195.