Title 20, Insurance

An individual hospital or medical expense insurance policy delivered or issued for delivery in this state more than one hundred twenty days after August 27, 1977 that provides that coverage of a dependent child shall terminate on attainment of the limiting age for dependent child…

The director may disapprove any disability policy form if the benefits provided in the policy form are unreasonable in relation to the premium charged.

A. A disability insurer is not obligated to pay any costs, other than covered patient costs, that are directly associated with a cancer clinical trial that is offered in this state and in which the insured participates voluntarily. A cancer clinical trial is a course of treatment…

A. Except as provided in sections 20-1379 and 20-2304, a disability insurer may offer one or more disability insurance policies that contain a choice of deductibles, coinsurance, copayments, out-of-pocket and any other cost sharing levels. Plans offered under this section shall c…

A. Any policy of disability insurance that is offered by a disability insurer and that contains a prescription drug benefit shall cover amino acid-based formula that is ordered by a physician or by a registered nurse practitioner if: 1. The insured has been diagnosed with an eosi…

A. A contract, entered into or renewed on or after January 1, 2011, between a disability insurer and a dentist who is licensed to practice in this state shall not require the dentist to provide services to an individual covered under a disability insurance policy based on a fee s…

A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a disability insurer and an optometrist who is licensed to practice in this state shall not: 1. Require the optometrist to provide a service to an indiv…

A. A disability insurance policy may limit coverage to an insured for a human organ transplant or posttransplant care if either of the following applies: 1. The transplant operation is performed in the People's Republic of China or the Hong Kong special administrative region. 2. …

If any policy is issued by a domestic insurer 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 has advised the director that any such policy is not subject to approval or…

A. Except as provided in subsection B of this section, each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in sections 20-1345 to 20-1356, inclusive, in the words in which such provisions appear, except that the ins…

There shall be a provision as follows: "Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer a…

A. There shall be a provision as follows: "Time limit on certain defenses: (a) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to …

A. There shall be a provision as follows: "Grace period: A grace period of ______________ (insert a number not less than 'seven' for weekly premium policies, 'ten' for monthly premium policies and 'thirty-one' for all other policies) days will be granted for the payment of each p…

A. There shall be a provision as follows: "Reinstatement: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept such premium, without requiring…

A. There shall be a provision as follows: "Notice of claim: Written notice of claim must be given to the insurer within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behal…

There shall be a provision as follows: "Claim forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such noti…

There shall be a provision as follows: "Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination…

There shall be a provision as follows: "Time of payment of claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment, will be paid immediately upon receipt of due written proof of such loss. Subject to due writt…

A. There shall be a provision as follows: "Payment of claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such desig…

There shall be a provision as follows: "Physical examinations and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make …

There shall be a provision as follows: "Legal actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action …

A. There shall be a provision as follows: "Change of beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change a beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrend…

Except as provided in subsection B of section 20-1344, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in sections 20-1358 to 20-1368, inclusive, unless the provisions are in the words in which …

There may be a provision as follows: "Change of occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to…

There may be 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."

A. There may be 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 _________________…

A. There may be 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 writt…

A. There may be 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 o…

A. There may be 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 month…

There may be 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."

There may be a provision as follows: "Cancellation: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his last address as shown by the records of the insurer, stating when, not less than thirty days thereafter, such cancellati…

There may be a provision as follows: "Conformity with statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state, District of Columbia or territory in which the insured resides on such date is hereby amended to conform to th…

There may be 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 occupa…

There may be 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."

The provisions which are the subject of sections 20-1345 to 20-1368, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the option of the i…

The word "insured," as used in this article shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, be…

Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this article and which is prescribed or required by the law …

No policy provision which is not subject to this article shall cause a policy, or any portion thereof to be less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this article. A policy delivered or issued for delivery to …

If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium aft…

A policy, rider or endorsement which could have been lawfully used or delivered or issued for delivery to any person in this state immediately prior to January 1, 1955, may be used or delivered or issued for delivery to any such person until January 1, 1957, without being subject…

Disability insurance on a franchise plan is declared to be that form of disability insurance issued to five or more employees of any corporation, copartnership or individual employer or any governmental corporation, agency or department thereof, or to ten or more members, employe…

A. Notwithstanding any provision of any disability insurance contract, benefits shall not be denied under the contract for any medical or surgical service performed by a holder of a license issued pursuant to title 32, chapter 7 or 11, or a registered nurse practitioner who is li…

If a disability insurance contract provides for or offers reimbursement for any service which is within the lawful scope of the practice of a chiropractor holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such cont…

If a disability insurance contract provides for or offers reimbursement for any service which is within the lawful scope of the practice of a psychologist holding a certificate or license issued by the state in which the services are rendered, a subscriber covered under such cont…

If a disability insurance contract provides or offers reimbursement for any service which is within the scope of the practice of a registered nurse practitioner or a certified registered nurse qualified under the rules adopted by the state board of nursing regarding extended nurs…

If a disability insurance contract provides coverage for occupational or physical therapy services, and provides both an in-network and out-of-network benefit, an insurer shall not deny a claim for covered occupational or physical therapy services obtained out-of-network solely o…