Section 3445*2. Employer sponsored group personal excess insurance  


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  • (a) For
      purposes of this section, the following definitions shall apply:
        (1) "Certificate" or "certificate  of  insurance"  means  any  policy,
      contract  or  other  evidence  of  insurance,  or  rider  or endorsement
      thereto, issued to a group member  under  an  employer  sponsored  group
      personal excess insurance policy.
        (2)  "Conditional  renewal" means any change of limits, change in type
      of coverage, reduction or elimination of coverage, increased  deductible
      or addition of exclusion, or increased premiums in excess of ten percent
      (exclusive  of  any premium increase generated as a result of experience
      rating, loss rating or retrospective rating).
        (3) "Employee" means an individual or  partner  who  receives  or  has
      received income, wages or salaries from the employer.
        (4)  "Employer"  means  a  person,  partnership,  corporation or other
      entity which pays or has paid income, wages or salaries to a  person  or
      persons.
        (5) "Employer sponsored group personal excess insurance" means a group
      policy of insurance providing the kind of insurance defined in paragraph
      thirteen  or  fourteen  of  subsection  (a)  of section one thousand one
      hundred thirteen of this chapter,  written  as  an  excess  policy  with
      premiums  remitted  by  the  employer,  insuring groups of active and/or
      retired employees designated by the employer.
        (6) "Group member" means a  designated  employee  insured  under  this
      section.
        (7)  "Group  policy"  means  employer  sponsored group personal excess
      insurance written for the designated employees of an employer.
        (b) Employer sponsored group personal excess insurance may be  written
      in this state pursuant to this section.
        (c)  The premium for the group policy may be paid by the employer from
      funds contributed:
        (1) wholly by the employer;
        (2) wholly by the employees; or
        (3) jointly by the employer and employees.
        (d) An employee shall have the right to refuse coverage offered by  an
      employer under this section.
        (e)  Each  policy  written  pursuant  to  this  section  shall provide
      separate limits of coverage for each group member.
        (f)(1) The insurer shall be responsible for the mailing or delivery to
      the employer a group policy and certificates of insurance for each group
      member insured under  the  group  policy.  The  insurer  shall  also  be
      responsible  for  the mailing or delivery to the employer for each group
      member any amended certificate  of  insurance,  or  endorsement  to  the
      certificate,  whenever there is a change of limits; addition, reduction,
      or elimination of coverage; or addition of an exclusion, under the group
      policy or certificate.
        (2) The certificate shall contain in substance all material terms  and
      conditions  of coverage afforded to the group member, including, but not
      limited to, the disclosure in clear and easily  understandable  language
      of  any limitations, exclusions or required underlying coverages, unless
      the group policy is incorporated by reference and a copy  of  the  group
      policy accompanies the certificate.
        (g)(1)  A  group policy or certificate shall not be subject to section
      three thousand four hundred twenty-five or section three  thousand  four
      hundred  twenty-six  of  this  article. The following requirements shall
      apply to authorized insurers in regard to termination of coverage.
        (2) A group policy or certificate may be cancelled by an insurer  only
      if  cancellation  is  based  on  one or more of the reasons set forth in
      paragraph one of subsection (c) of section three thousand  four  hundred
    
      twenty-six  of this article, provided, however, that an individual group
      member may also be canceled upon termination of his  or  her  employment
      with the employer.
        (3)  An  insurer's cancellation of a group policy, or any certificate,
      shall not become effective until forty-five  days,  or  twenty  days  if
      based  upon  non-payment of premium, after the insurer mails or delivers
      written notice of cancellation to the employer at  the  mailing  address
      shown  in  the policy. The employer shall mail or deliver written notice
      of such cancellation to each affected group member within  ten  days  of
      receiving  a  cancellation  notice  from  the insurer advising the group
      member of the cancellation and the effective date of the cancellation.
        (h) An authorized insurer may nonrenew or conditionally renew a  group
      policy,  or  any  certificate,  under  this section, for any reason upon
      forty-five days written notice to the employer. The employer shall  mail
      or  deliver  written notice of such nonrenewal or conditional renewal to
      each affected group member within ten days of receiving such notice from
      the insurer.
        (i) An employer may cancel a group policy, or any certificate, for any
      reason upon thirty days written notice to the insurer and each  affected
      group member.
        (j)  Unless  a  group  policy provides for a longer policy period, the
      policy and all certificates shall be issued or renewed  for  a  one-year
      policy  period  commencing  with a common inception date. A new employee
      may be added to the group policy for less than one year to conform  with
      a common expiration date.
        (k)  No  policy  form  shall be delivered or issued for delivery by an
      authorized insurer unless it has been filed with the superintendent  and
      the  superintendent  has either approved it, or thirty days have elapsed
      and the superintendent has not disapproved such form  as  misleading  or
      violative  of public policy. The initial rate of filing pursuant to this
      section shall be subject to the prior approval  of  the  superintendent,
      and any subsequent rate filing shall not be subject to prior approval.
        * NB There are 2 § 3445's