§ 26-19-107 — Group disability and blanket insurance standard provisions; exceptions

Wyoming § 26-19-107

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 19: GROUP AND BLANKET DISABILITY INSURANCE

Text

(a) A policy of group disability or blanket disability
insurance shall not be delivered in this state unless it
contains in substance the following provisions or provisions
which in the commissioner's opinion are more favorable to the
persons insured or at least as favorable to the persons insured
and more favorable to the policyholder:
(i) The policy, including endorsements and a copy of
the application, if any, of the policyholder and the persons
insured constitutes the entire contract between the parties;
(ii) Written notice of a claim shall be given to the
insurer within twenty (20) days after the occurrence or
commencement of any loss covered by the policy. Failure to give
notice within the time provided by this paragraph shall not
invalidate nor reduce any claim if it is shown it was not
reasonably possible to give notice and that notice was given as
soon as was reasonably possible;
(iii) The insurer shall furnish either to the person
making a claim or to the policyholder for delivery to the person
making a claim the forms it usually furnishes for filing proof
of loss. If the forms are not furnished before the expiration of
fifteen (15) days after giving of the notice specified in
paragraph (ii) of this subsection, the person making the claim
is deemed to have complied with the requirements of the policy
as to proof of loss upon submitting, within the time fixed in
the policy for filing proof of loss, written proof covering the
occurrence, the character and the extent of the loss for which
claim is made;
(iv) In the case of claim for loss of time for
disability, written proof of the loss shall be furnished to the
insurer within ninety (90) days after the commencement of the
period for which the insurer is liable. Subsequent written
proofs of the continuance of the disability shall be furnished
to the insurer at any intervals the insurer reasonably requires.
In the case of claim for any other loss, written proof of the
loss shall be furnished to the insurer within ninety (90) days
after the date of the loss. Failure to furnish proof within the
time provided by this paragraph shall not invalidate nor reduce
any claim if it is shown it was not reasonably possible to
furnish proof and that proof was furnished as soon as was
reasonably possible;
(v) Any benefits payable under the policy are payable
as follows:
(A) Benefits other than benefits for loss of
time are payable not more than forty-five (45) days after
receipt of written proof of the loss and supporting evidence;
(B) Subject to proof of loss and supporting
evidence, all accrued benefits payable under a policy for loss
of time are payable not less frequently than monthly during the
continuance of the disability period for which the insurer is
liable, and any balance remaining unpaid at the termination of
the disability period is payable immediately upon receipt of
proof and supporting evidence.
(vi) The insurer, at its own expense, may:
(A) Examine the person of the insured when and
as often as it reasonably requires during the pendency of claim
under the policy; and
(B) Make an autopsy if it is not prohibited by
law.
(vii) No action at law or in equity shall be brought
to recover under the policy prior to the expiration of sixty
(60) days after written proof of loss is furnished in accordance
with the requirements of the policy and no action shall be
brought upon the expiration of three (3) years after the time
written proof of loss is required to be furnished;
(viii) The policyholder is entitled to a grace period
of thirty-one (31) days for the payment of any premium due
except the first, and during the grace period the policy shall
continue in force unless the policyholder gave the insurer
written notice of discontinuance in advance of the date of
discontinuance and in accordance with the terms of the policy.
The policy may provide that the policyholder is liable to the
insurer for the payment of a pro rata premium for the time the
policy was in force during the grace period provided by this
paragraph;
(ix) The validity of the policy shall not be
contested except for nonpayment of premiums after it has been in
force for two (2) years from the date of issue, and no statement
made by any person covered under the policy relating to
insurability shall be used in contesting the validity of the
insurance with respect to which the statement was made after the
insurance has been in force prior to the contest for a period of
two (2) years during the person's lifetime unless the statement
is contained in a written instrument signed by the person making
the statement;
(x) A copy of the application, if any, of the
policyholder shall be attached to the policy when issued. All
statements made by the policyholder or by the persons insured
are deemed representations and not warranties. No statement
made by any person insured shall be used in any contest unless a
copy of the instrument containing the statement is or has been
furnished to the person or, in the event of the death or
incapacity of the insured person, to the individual's
beneficiary or personal representative;
(xi) The additional exclusions or limitations, if
any, applicable under the policy concerning a disease or
physical condition of a person, not otherwise excluded from the
person's coverage by name or specific description effective on
the date of the person's loss, which existed prior to the
effective date of the person's coverage under the policy shall
be specified. The exclusion or limitation shall not exclude
coverage for a period beyond twelve (12) months following the
individual's effective date of coverage and shall only relate to
conditions for which medical advice, diagnosis, care or
treatment was recommended or received during the six (6) months
immediately preceding the effective date of coverage. In
determining whether a preexisting condition provision applies to
an insured or dependent, all private or public health benefit
plans shall credit the time the person was previously covered by
a private or public health benefit plan if the previous coverage
was continuous to a date not more than ninety (90) days prior to
the effective date of the new coverage exclusive of any
applicable waiting period. In the case of a preexisting
conditions limitation allowable in the succeeding carrier's
plan, the level of benefits applicable to preexisting conditions
of persons becoming covered by the succeeding carrier's plan
during the period of time this limitation applies under the new
plan shall be the lesser of:
(A) The benefits of the new plan determined
without application of the preexisting conditions limitation; or
(B) The benefits of the prior plan.
(xii) If the premiums or benefits vary by age, a
provision shall specify an equitable adjustment of premiums,
benefits, or both, to be made if the age of a covered person has
been misstated and containing a clear statement of the method of
adjustment to be used;
(xiii) The insurer shall issue to the policyholder
for delivery to each person insured a certificate containing a
statement of the insurance protection to which that person is
entitled, to whom the insurance benefits are payable and of any
family member's or dependent's coverage;
(xiv) Benefits for loss of life of the person insured
are payable to the beneficiary designated by the person insured
or if the policy contains conditions pertaining to family status
the beneficiary may be the family member specified by the policy
terms. Payment of benefits for loss of life of the person
insured is subject to the provisions of the policy in the event
no designated or specified beneficiary is living at the death of
the person insured. All other benefits of the policy are
payable to the person insured. The policy may provide that if
any benefit is payable to the estate of a person or to a person
who is a minor or otherwise not competent to give a valid
release, the insurer may pay the benefit, up to an amount not
exceeding five thousand dollars ($5,000.00), to any relative by
blood, marriage or adoption of the person deemed by the insurer
to be equitably entitled to the benefits;
(xv) For a policy insuring debtors, the insurer shall
furnish the policyholder for delivery to each debtor insured
under the policy a certificate of insurance describing the
coverage and specifying that the benefits payable shall first be
applied to reduce or extinguish the indebtedness;
(xvi) Repealed By Laws 1997, ch. 120, § 2.
(xvii) Repealed by Laws 2025, ch. 114, § 2.
(b) W.S. 26-19-107(a)(xi), (xiii) and (xiv) shall not
apply to policies insuring debtors.
(c) The standard provisions for individual disability
insurance policies shall not apply to group disability insurance
policies.
(d) If any provision of this section is entirely or
partially inapplicable to or inconsistent with the coverage
provided by a particular form of policy, the insurer with the
approval of the commissioner shall omit from the policy any
inapplicable provision or part of a provision and shall modify
any inconsistent provision or part of the provision to conform
the policy provision with the coverage provided by the policy.
(e) Repealed By Laws 1997, ch. 120, § 2.
(f) No policy of group or blanket disability insurance
shall treat the following as a preexisting condition:
(i) Pregnancy existing on the effective date of
coverage;
(ii) Genetic information, in the absence of a
diagnosis of a condition related to the genetic information.
(g) A policy of group or blanket disability insurance
shall not establish rules for eligibility, including continued
eligibility, of any individual to enroll under the policy based
on any of the following health status related factors in
relation to the employee or an eligible dependent:
(i) Health status;
(ii) Medical condition, including both physical and
mental illness;
(iii) Claims experience;
(iv) Receipt of health care;
(v) Medical history;
(vi) Genetic information;
(vii) Evidence of insurability, including conditions
arising out of acts of domestic violence;
(viii) Disability.
(h) Repealed by Laws 2025, ch. 114, § 2.
(j) All group and blanket disability insurance policies
providing coverage on an expense incurred basis, group service
or indemnity type contracts issued by a nonprofit corporation,
group service contracts issued by a health maintenance
organization, all self-insured group arrangements to the extent
not preempted by federal law and all managed health care
delivery entities of any type or description, that are
delivered, issued for delivery, continued or renewed on or after
July 1, 2001, and providing coverage to any resident of this
state shall provide benefits or coverage for:
(i) A pelvic examination and pap smear for any
nonsymptomatic women covered under the policy or contract;
(ii) A colorectal cancer examination and laboratory
tests for cancer for any nonsymptomatic person covered under the
policy or contract;
(iii) A prostate examination and laboratory tests for
cancer for any nonsymptomatic man covered under the policy or
contract; and
(iv) A breast cancer examination including a
screening mammogram and clinical breast examination for any
nonsymptomatic person covered under the policy or contract.
(k) To encourage public health and diagnostic health
screenings, the services covered under subsection (j) of this
section shall be provided with no deductible due and payable. A
health plan shall, at a minimum, be liable for eighty percent
(80%) of the reimbursement allowance of the health plan up to a
maximum of two hundred fifty dollars ($250.00) per adult insured
per year. A patient shall be liable for coinsurance up to twenty
percent (20%) if such coinsurance is required pursuant to the
patient's health care coverage. Coverage may be in addition to
any other preventive care services. This subsection shall apply
to private health benefit plans as defined by W.S.
26-1-102(a)(xxxiii) except that it shall not apply to high
deductible policies where the deductible equals or exceeds one
thousand dollars ($1,000.00) per person or per family per year
or policies qualifying as federal medical savings accounts.
(m) In addition to the prohibitions on the use of genetic
information provided in paragraph (g)(vi) of this section, an
insurer offering a policy of group or blanket disability
insurance shall not, based on the genetic testing information of
an individual or a family member of an individual:
(i) Deny eligibility;
(ii) Adjust premium rates;
(iii) Adjust contribution rates;
(iv) Request or require predictive genetic testing
information concerning an individual or a family member of the
individual, except the insurer may request, but not require,
predictive genetic testing information if needed for diagnosis,
treatment or payment. As part of a request under this paragraph,
the plan or issuer shall provide a description of the procedures
in place to safeguard confidentiality of the information.