Title 33, Chapter 30, Section 6
( 33-30-6)
(a) Any insurance company authorized to write accident and sickness insurance in this state shall have the power to issue blanket accident and sickness insurance. No blanket policy may be issued or delivered in this state unless a copy of the form of the blanket policy shall have been filed in accordance with Code Section 33-24-9. (b) Every blanket policy shall contain provisions which in the
opinion of the Commissioner are at least as favorable to the
policyholder and the individual insured as the following: (1) A provision that the policy and the application shall
constitute the entire contract between the parties, and that all
statements made by the policyholder shall, in absence of fraud, be
deemed representations and not warranties, and that no such
statements shall be used in defense to a claim under the policy,
unless contained in a written application; (2) A provision that written notice of sickness or of injury must
be given to the insurer within 20 days after the date when such
sickness or injury occurred. Failure to give notice within that
time shall neither invalidate nor reduce any claim if it shall be
shown not to have been reasonably possible to give the notice and
that notice was given as soon as was reasonably possible; (3) A provision that the insurer will furnish to the policyholder
such forms as are usually furnished by it for filing proof of
loss. If the forms are not furnished before the expiration of ten
working days after the giving of notice, the claimant shall be
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,
character, and extent of the loss for which claim is made; (4) A provision that in the case of claim for loss of time for
disability, written proof of the loss must be furnished to the
insurer within 30 days after the commencement of the period for
which the insurer is liable, and that subsequent written proofs of
the continuance of the disability must be furnished to the insurer
at such intervals as the insurer may reasonably require, and that
in the case of claim for any other loss, written proof of the loss
must be furnished to the insurer within 90 days after the date of
the loss. Failure to furnish the proof within such time shall
neither invalidate nor reduce any claim if it shall be shown not
to have been reasonably possible to furnish the proof and that the
proof was furnished as soon as was reasonably possible; (5) A provision incorporating and restating the substance of the provisions of subsections (b) and (c) of Code Section 33-24-59.5, relating to time limits for payment of claims for benefits under health benefit policies and sanctions for failure to pay timely. If a policy provides benefits for loss of time, such policy shall also provide that, subject to proof of such loss, all accrued benefits payable under the policy for loss of time will be paid not later than at the expiration of each period of 30 days during the continuance of the period for which the insurer is liable and any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of such proof; (6) A provision that the insurer, at its own expense, shall have the right and opportunity to examine the person of the insured when and so often as it may reasonably require during the pendency of a claim under the policy and shall also have the right and opportunity to make an autopsy in case of death, if an autopsy is not prohibited by law; (7) A provision that no action at law or in equity shall be
brought to recover under the policy prior to the expiration of 60
days after written proof of loss has been furnished in accordance
with the requirements of the policy, and that no action shall be
brought after the expiration of three years after the time written
proof of loss is required to be furnished; and (8) A provision that, with respect to termination of benefits for,
or coverage of, any person who is a dependent child of an insured,
the child shall continue to be insured up to and including age 25
so long as the coverage of the insured parent or guardian
continues in effect, the child remains a dependent of the parent
or guardian, and the child, in each calendar year since reaching
any age specified for termination of benefits as a dependent, has
been enrolled for five months or more as a full-time student at a
postsecondary institution of higher learning or, if not so
enrolled, would have been eligible to be so enrolled and was
prevented from being so enrolled due to illness or injury. (c) The provisions of this Code section shall also apply to group
and blanket accident and sickness insurance policies issued by a
fraternal benefit society, a hospital service nonprofit corporation,
a nonprofit medical service corporation, a health care corporation,
a health maintenance organization, or any other similar entity. |