Except as provided in sections 44-710.05 and 44-787 , no policy
of sickness and accident insurance delivered or issued for delivery to any
person in this state shall contain provisions respecting the matters set forth
below unless such provisions are in the words in which the provisions appear
in this section, except that the insurer may, at its option, use in lieu of
any such provision a corresponding provision of different wording approved
by the Director of Insurance which is not less favorable in any respect to
the insured or the beneficiary. Any such provision contained in the policy
shall be preceded individually by the appropriate caption appearing in this
section or, at the option of the insurer, by such appropriate individual or
group captions or subcaptions as the Director of
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Except as provided in sections 44-710.05 and 44-787 , no policy
of sickness and accident insurance delivered or issued for delivery to any
person in this state shall contain provisions respecting the matters set forth
below unless such provisions are in the words in which the provisions appear
in this section, except that the insurer may, at its option, use in lieu of
any such provision a corresponding provision of different wording approved
by the Director of Insurance which is not less favorable in any respect to
the insured or the beneficiary. Any such provision contained in the policy
shall be preceded individually by the appropriate caption appearing in this
section or, at the option of the insurer, by such appropriate individual or
group captions or subcaptions as the Director of Insurance may approve.
(1) A provision as follows: CHANGE OF OCCUPATION: If the insured
be injured or contract sickness after having changed his or her occupation
to one classified by the insurer as more hazardous than that stated in this
policy or while doing for compensation anything pertaining to an occupation
so classified, the insurer will pay only such portion of the indemnities provided
in this policy as the premium paid would have purchased at the rates and within
the limits fixed by the insurer for such more hazardous occupation. If the
insured changes his or her occupation to one classified by the insurer as
less hazardous than that stated in this policy, the insurer, upon receipt
of proof of such change of occupation, will reduce the premium rate accordingly
and will return the excess pro rata unearned premium from the date of change
of occupation or from the policy anniversary date immediately preceding receipt
of such proof, whichever is the more recent. In applying this provision, the
classification of occupational risk and the premium rates shall be such as
have been last filed by the insurer prior to the occurrence of the loss for
which the insurer is liable or prior to date of proof of change in occupation
with the state official having supervision of insurance in the state where
the insured resided at the time this policy was issued; but if such filing
was not required, then the classification of occupational risk and the premium
rates shall be those last made effective by the insurer in such state prior
to the occurrence of the loss or prior to the date of proof of change of occupation.
(2) A provision as follows: MISSTATEMENT OF AGE: If the age
of the insured has been misstated, all amounts payable under this policy shall
be such as the premium paid would have purchased at the correct age.
(3) Except as provided in subdivision (6)
of this section, a provision as follows: OTHER INSURANCE IN THIS
INSURER: If an accident or sickness or accident and sickness policy or policies
previously issued by the insurer to the insured be in force concurrently herewith,
making the aggregate indemnity for ................ (insert type of coverage
or coverages) in excess of $................ (insert maximum limit of indemnity
or indemnities), the excess insurance shall be void and all premiums paid
for such excess shall be returned to the insured or to his or her estate;
or in lieu thereof: Insurance effective at any one time on the insured under
a like policy or policies in this insurer is limited to the one such policy
elected by the insured, his or her beneficiary, or his or her estate, as the
case may be, and the insurer will return all premiums paid for all other such
policies.
(4) Except as provided in subdivision (6)
of this section, a provision as follows: INSURANCE WITH OTHER
INSURERS: If there be other valid coverage, not with this insurer, providing
benefits for the same loss on a provision-of-service basis or on an expense-incurred
basis and of which this insurer has not been given written notice prior to
the occurrence or commencement of loss, the only liability under any expense-incurred
coverage of this policy shall be for such proportion of the loss as the amount
which would otherwise have been payable hereunder plus the total of the like
amounts under all such other valid coverages for the same loss of which this
insurer had notice bears to the total like amounts under all valid coverages
for such loss and for the return of such portion of the premiums paid as shall
exceed the pro rata portion for the amount so determined. For the purpose
of applying this provision when other coverage is on a provision-of-service
basis, the like amount of such other coverage shall be taken as the amount
which the services rendered would have cost in the absence of such coverage.
If the foregoing policy provision is included in a policy which also contains
the next following policy provision there shall be added to the caption of
the foregoing provision the phrase .... EXPENSE-INCURRED BENEFITS. The insurer
may, at its option, include in this provision a definition of other valid
coverage, approved as to form by the Director of Insurance, which definition
shall be limited in subject matter to coverage provided by organizations subject
to regulation by insurance law or by insurance authorities of this or any
other state of the United States or any province of Canada and by hospital
or medical service organizations and to any other coverage the inclusion of
which may be approved by the Director of Insurance. In the absence of such
definition such term shall not include group insurance, automobile medical
payments insurance, or coverage provided by hospital or medical service organizations
or by union welfare plans or employer or employee benefit organizations. For
the purpose of applying the foregoing policy provision with respect to any
insured, any amount of benefit provided for such insured pursuant to any compulsory
benefit statute, including any workers' compensation or employers liability
statute, whether provided by a governmental agency or otherwise shall in all
cases be deemed to be other valid coverage of which the insurer has had notice.
In applying the foregoing policy provision no third-party liability coverage
shall be included as other valid coverage.
(5) Except as provided in subdivision (6)
of this section, a provision as follows: INSURANCE WITH OTHER
INSURERS: If there be other valid coverage, not with this insurer, providing
benefits for the same loss on other than an expense-incurred basis and of
which this insurer has not been given written notice prior to the occurrence
or commencement of loss, the only liability for such benefits under this policy
shall be for such proportion of the indemnities otherwise provided hereunder
for such loss as the like indemnities of which the insurer had notice (including
the indemnities under this policy) bear to the total amount of all like indemnities
for such loss, and for the return of such portion of the premium paid as shall
exceed the pro rata portion for the indemnities thus determined. If the foregoing
policy provision is included in a policy which also contains the next preceding
policy provision, there shall be added to the caption of the foregoing provision
the phrase .... OTHER BENEFITS. The insurer may, at its option, include in
this provision a definition of other valid coverage, approved as to form by
the Director of Insurance, which definition shall be limited in subject matter
to coverage provided by organizations subject to regulation by insurance law
or by insurance authorities of this or any other state of the United States
or any province of Canada and to any other coverage the inclusion of which
may be approved by the Director of Insurance. In the absence of such definition
such term shall not include group insurance or benefits provided by union
welfare plans or by employer or employee benefit organizations. For the purpose
of applying the foregoing policy provision with respect to any insured, any
amount of benefit provided for such insured pursuant to any compulsory benefit
statute, including any workers' compensation or employers liability statute,
whether provided by a governmental agency or otherwise shall in all cases
be deemed to be other valid coverage of which the insurer has had notice.
In applying the foregoing policy provision no third-party liability coverage
shall be included as other valid coverage.
(6) In lieu
of the provisions set forth in subdivisions (3) through (5) of this section
but subject to section 44-3,159 , the insurer may at its option include a provision
entitled COORDINATION OF BENEFITS which provides for nonduplication and coordination
between two or more coverages based on rules and regulations adopted and promulgated
by the director.
(7) A
provision as follows: RELATION OF EARNINGS TO INSURANCE: If the total monthly
amount of loss-of-time benefits promised for the same loss under all valid
loss-of-time coverage upon the insured, whether payable on a weekly or monthly
basis, shall exceed the monthly earnings of the insured at the time disability
commenced or his or her average monthly earnings for the period of two years
immediately preceding a disability for which claim is made, whichever is the
greater, the insurer will be liable only for such proportionate amount of
such benefits under this policy as the amount of such monthly earnings or
such average monthly earnings of the insured bears to the total amount of
monthly benefits for the same loss under all such coverage upon the insured
at the time such disability commences and for the return of such part of the
premiums paid during such two years as shall exceed the pro rata amount of
the premiums for the benefits actually paid hereunder; but this shall not
operate to reduce the total monthly amount of benefits payable under all such
coverage upon the insured below the sum of two hundred dollars or the sum
of the monthly benefits specified in such coverages, whichever is the lesser,
nor shall it operate to reduce benefits other than those payable for loss
of time. The foregoing policy provision may be inserted only in a policy which
the insured has the right to continue in force subject to its terms by the
timely payment of premiums (a) until at least age fifty or (b) in the case
of a policy issued after age forty-four for at least five years from its date
of issue. The insurer may, at its option, include in this provision a definition
of valid loss-of-time coverage, approved as to form by the Director of Insurance,
which definition shall be limited in subject matter to coverage provided by
governmental agencies or by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the United States
or any province of Canada or to any other coverage the inclusion of which
may be approved by the Director of Insurance or any combination of such coverages.
In the absence of such definition such term shall not include any coverage
provided for such insured pursuant to any compulsory benefit statute, including
any workers' compensation or employers liability statute, or benefits provided
by union welfare plans or by employer or employee benefit organizations.
(8) A provision as follows:
UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium
then due and unpaid or covered by any note or written order may be deducted
therefrom.
(9) A provision as follows:
CANCELLATION: The insurer may cancel this policy at any time by written notice
delivered to the insured which shall be effective only if mailed by certified
or registered mail to the named insured at his or her last-known address,
as shown by the records of the insurer, at least thirty days prior to the
effective date of cancellation, except that cancellation due to failure to
pay the premium or in cases of fraud or misrepresentation shall not require
that such notice be given at least thirty days prior to cancellation. Subject
to any provisions in the policy or a grace period, cancellation for failure
to pay a premium shall be effective as of midnight of the last day for which
the premium has been paid. In cases of fraud or misrepresentation, coverage
shall be canceled upon the date of the notice or any later date designated
by the insurer. After the policy has been continued beyond its original term
the insured may cancel this policy at any time by written notice delivered
or mailed to the insurer, effective upon receipt or on such later date as
may be specified in such notice. In the event of cancellation, the insurer
will return promptly the unearned portion of any premium paid. If the insured
cancels, the earned premium shall be computed by the use of the short-rate
table last filed with the state official having supervision of insurance in
the state where the insured resided when the policy was issued. If the insurer
cancels, the earned premium shall be computed pro rata. Cancellation shall
be without prejudice to any claim originating prior to the effective date
of cancellation.
(10) A provision as follows:
ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which
a contributing cause was the insured's commission of or attempt to commit
a felony or to which a contributing cause was the insured's being engaged
in an illegal occupation.
(11) A provision as follows:
INTOXICANTS AND NARCOTICS: The insurer shall not be liable for any loss sustained
or contracted in consequence of the insured's being intoxicated or under the
influence of any narcotic unless administered on the advice of a physician.