Missouri Revised Statutes
Chapter 376
Life, Health and Accident Insurance
←376.425
Section 376.426.1
376.427→
August 28, 2015
Group health policies, required provisions.
376.426. No policy of group health insurance shall be delivered in
this state unless it contains in substance the following provisions, or
provisions which in the opinion of the director of the department of
insurance, financial institutions and professional registration are more
favorable to the persons insured or at least as favorable to the persons
insured and more favorable to the policyholder; except that: provisions in
subdivisions (5), (7), (12), (15), and (16) of this section shall not apply
to policies insuring debtors; standard provisions required for individual
health insurance policies shall not apply to group health insurance
policies; and if any provision of this section is in whole or in part
inapplicable to or inconsistent with the coverage provided by a particular
form of policy, the insurer, with the approval of the director, shall omit
from such policy any inapplicable provision or part of a provision, and
shall modify any inconsistent provision or part of the provision in such
manner as to make the provision as contained in the policy consistent with
the coverage provided by the policy:
(1) A provision that the policyholder is entitled to a grace period
of thirty-one days for the payment of any premium due except the first,
during which grace period the policy shall continue in force, unless the
policyholder shall have given 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 shall be
liable to the insurer for the payment of a pro rata premium for the time
the policy was in force during such grace period;
(2) A provision that the validity of the policy shall not be
contested, except for nonpayment of premiums, after it has been in force
for two years from its date of issue, and that 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 such
statement was made after such insurance has been in force prior to the
contest for a period of two years during such person's lifetime nor unless
it is contained in a written instrument signed by the person making such
statement; except that, no such provision shall preclude the assertion at
any time of defenses based upon the person's ineligibility for coverage
under the policy or upon other provisions in the policy;
(3) A provision that a copy of the application, if any, of the
policyholder shall be attached to the policy when issued, that all
statements made by the policyholder or by the persons insured shall be
deemed representations and not warranties and that 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 such person or, in the
event of the death or incapacity of the insured person, to the individual's
beneficiary or personal representative;
(4) A provision setting forth the conditions, if any, under which the
insurer reserves the right to require a person eligible for insurance to
furnish evidence of individual insurability satisfactory to the insurer as
a condition to part or all of the individual's coverage;
(5) A provision specifying the additional exclusions or limitations,
if any, applicable under the policy with respect to 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. Any such exclusion or limitation may only apply to a disease
or physical condition for which medical advice or treatment was received by
the person during the twelve months prior to the effective date of the
person's coverage. In no event shall such exclusion or limitation apply to
loss incurred or disability commencing after the earlier of:
(a) The end of a continuous period of twelve months commencing on or
after the effective date of the person's coverage during all of which the
person has received no medical advice or treatment in connection with such
disease or physical condition; or
(b) The end of the two-year period commencing on the effective date
of the person's coverage;
(6) If the premiums or benefits vary by age, there shall be a
provision specifying an equitable adjustment of premiums or of benefits, or
both, to be made in the event the age of the covered person has been
misstated, such provision to contain a clear statement of the method of
adjustment to be used;
(7) A provision that the insurer shall issue to the policyholder, for
delivery to each person insured, a certificate setting forth a statement as
to the insurance protection to which that person is entitled, to whom the
insurance benefits are payable, and a statement as to any family member's
or dependent's coverage;
(8) A provision that 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. Failure to give notice within such time shall not
invalidate nor reduce any claim if it shall be shown not to have been
reasonably possible to give such notice and that notice was given as soon
as was reasonably possible;
(9) A provision that the insurer shall furnish to the person making
claim, or to the policyholder for delivery to such person, such forms as
are usually furnished by it for filing proof of loss. If such forms are
not furnished before the expiration of fifteen days after the insurer
receives notice of any claim under the policy, the person making such claim
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;
(10) A provision that in the case of claim for loss of time for
disability, written proof of such loss must be furnished to the insurer
within ninety days after the commencement of the period for which the
insurer is liable, and that subsequent written proofs of the continuance of
such 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 such loss must be furnished to the insurer within
ninety days after the date of such loss. Failure to furnish such proof
within such time shall not invalidate nor reduce any claim if it was not
reasonably possible to furnish such proof within such time, provided such
proof is furnished as soon as reasonably possible and in no event, except
in the absence of legal capacity of the claimant, later than one year from
the time proof is otherwise required;
(11) A provision that all benefits payable under the policy other
than benefits for loss of time shall be payable not more than thirty days
after receipt of proof and that, subject to due proof of loss, all accrued
benefits payable under the policy for loss of time shall be paid not less
frequently than monthly during the continuance of the period for which the
insurer is liable, and that any balance remaining unpaid at the termination
of such period shall be paid as soon as possible after receipt of such
proof;
(12) A provision that benefits for accidental loss of life of a
person insured shall be 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. In
either case, payment of these benefits is subject to the provisions of the
policy in the event no such designated or specified beneficiary is living
at the death of the person insured. All other benefits of the policy shall
be payable to the person insured. The policy may also 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
such benefit, up to an amount not exceeding two thousand dollars, to any
relative by blood or connection by marriage of such person who is deemed by
the insurer to be equitably entitled thereto;
(13) A provision that the insurer shall have the right and
opportunity, at the insurer's own expense, to examine the person of the
individual for whom claim is made when and so often as it may reasonably
require during the pendency of the claim under the policy and also the
right and opportunity, at the insurer's own expense, to make an autopsy in
case of death where it is not prohibited by law;
(14) A provision that no action at law or in equity shall be brought
to recover on the policy prior to the expiration of sixty days after proof
of loss has been filed in accordance with the requirements of the policy
and that no such action shall be brought at all unless brought within three
years from the expiration of the time within which proof of loss is
required by the policy;
(15) A provision specifying the conditions under which the policy may
be terminated. Such provision shall state that except for nonpayment of
the required premium or the failure to meet continued underwriting
standards, the insurer may not terminate the policy prior to the first
anniversary date of the effective date of the policy as specified therein,
and a notice of any intention to terminate the policy by the insurer must
be given to the policyholder at least thirty-one days prior to the
effective date of the termination. Any termination by the insurer shall be
without prejudice to any expenses originating prior to the effective date
of termination. An expense will be considered incurred on the date the
medical care or supply is received;
(16) A provision stating that if a policy provides that coverage of a
dependent child terminates upon attainment of the limiting age for
dependent children specified in the policy, such policy, so long as it
remains in force, shall be deemed to provide that attainment of such
limiting age does not operate to terminate the hospital and medical
coverage of such child while the child is and continues to be both
incapable of self-sustaining employment by reason of mental or physical
handicap and chiefly dependent upon the certificate holder for support and
maintenance. Proof of such incapacity and dependency must be furnished to
the insurer by the certificate holder at least thirty-one days after the
child's attainment of the limiting age. The insurer may require at
reasonable intervals during the two years following the child's attainment
of the limiting age subsequent proof of the child's incapacity and
dependency. After such two-year period, the insurer may require subsequent
proof not more than once each year. This subdivision shall apply only to
policies delivered or issued for delivery in this state on or after one
hundred twenty days after September 28, 1985;
(17) A provision stating that if a policy provides that coverage of a
dependent child terminates upon attainment of the limiting age for
dependent children specified in the policy, such policy, so long as it
remains in force, until the dependent child attains the limiting age, shall
remain in force at the option of the certificate holder. Eligibility for
continued coverage shall be established where the dependent child is:
(a) Unmarried and no more than that twenty-five years of age; and
(b) A resident of this state; and
(c) Not provided coverage as a named subscriber, insured, enrollee,
or covered person under any group or individual health benefit plan, or
entitled to benefits under Title XVIII of the Social Security Act, P.L.
89-97, 42 U.S.C. Section 1395, et seq.;
(18) In the case of a policy insuring debtors, a provision that the
insurer shall furnish to 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;
*(19) Notwithstanding any other provision of law to the contrary, a
health carrier, as defined in section 376.1350, may offer a health benefit
plan that is a managed care plan that requires all health care services to
be delivered by a participating provider in the health carrier's network,
except for emergency services, as defined in section 376.1350, and the
services described in subsection 4 of section 376.811. Such a provision
shall be disclosed in clear, conspicuous, and understandable language in
the enrollment application and in the policy form. Whenever a health
carrier offers a health benefit plan pursuant to this subdivision to a
group contract holder as an exclusive or full replacement health benefit
plan the health carrier shall offer at least one additional health benefit
plan option that includes an out-of-network benefit. The decision to
accept or reject the offer of the option of a health benefit plan that
includes an out-of-network benefit shall be made by the enrollee and not
the group contract holder;
*(20) A provision stating that a health benefit plan issued pursuant
to subdivision (19) of this section shall have in place a procedure by
which an enrollee may obtain a referral to a nonparticipating provider when
the enrollee is diagnosed with a life-threatening condition or disabling
degenerative disease.
The provisions of subdivisions (19) and (20) of this section shall expire
and be null and void at the end of the calendar year following the repeal
of 42 U.S.C. Section 300gg by the United States Congress or at the end of
the calendar year following a finding by a court of competent jurisdiction
that such section is unconstitutional or otherwise infirm.
(L. 1985 H.B. 623, A.L. 2007 H.B. 818, A.L. 2013 S.B. 262)
*Contingent expiration date
2008
1991
2008
376.426. No policy of group health insurance shall be delivered in this
state unless it contains in substance the following provisions, or provisions
which in the opinion of the director of the department of insurance, financial
institutions and professional registration are more favorable to the persons
insured or at least as favorable to the persons insured and more favorable to
the policyholder; except that: provisions in subdivisions (5), (7), (12),
(15), and (16) of this section shall not apply to policies insuring debtors;
standard provisions required for individual health insurance policies shall
not apply to group health insurance policies; and if any provision of this
section is in whole or in part inapplicable to or inconsistent with the
coverage provided by a particular form of policy, the insurer, with the
approval of the director, shall omit from such policy any inapplicable
provision or part of a provision, and shall modify any inconsistent provision
or part of the provision in such manner as to make the provision as contained
in the policy consistent with the coverage provided by the policy:
(1) A provision that the policyholder is entitled to a grace period of
thirty-one days for the payment of any premium due except the first, during
which grace period the policy shall continue in force, unless the
policyholder shall have given 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 shall be liable to the
insurer for the payment of a pro rata premium for the time the policy was in
force during such grace period;
(2) A provision that the validity of the policy shall not be contested,
except for nonpayment of premiums, after it has been in force for two years
from its date of issue, and that 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 such statement was made after
such insurance has been in force prior to the contest for a period of two
years during such person's lifetime nor unless it is contained in a written
instrument signed by the person making such statement; except that, no such
provision shall preclude the assertion at any time of defenses based upon the
person's ineligibility for coverage under the policy or upon other provisions
in the policy;
(3) A provision that a copy of the application, if any, of the
policyholder shall be attached to the policy when issued, that all statements
made by the policyholder or by the persons insured shall be deemed
representations and not warranties and that 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 such person or, in the
event of the death or incapacity of the insured person, to the individual's
beneficiary or personal representative;
(4) A provision setting forth the conditions, if any, under which the
insurer reserves the right to require a person eligible for insurance to
furnish evidence of individual insurability satisfactory to the insurer as a
condition to part or all of the individual's coverage;
(5) A provision specifying the additional exclusions or limitations, if
any, applicable under the policy with respect to 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. Any such exclusion or limitation may only apply to a disease or
physical condition for which medical advice or treatment was received by the
person during the twelve months prior to the effective date of the person's
coverage. In no event shall such exclusion or limitation apply to loss
incurred or disability commencing after the earlier of:
(a) The end of a continuous period of twelve months commencing on or
after the effective date of the person's coverage during all of which the
person has received no medical advice or treatment in connection with such
disease or physical condition; or
(b) The end of the two-year period commencing on the effective date of
the person's coverage;
(6) If the premiums or benefits vary by age, there shall be a provision
specifying an equitable adjustment of premiums or of benefits, or both, to be
made in the event the age of the covered person has been misstated, such
provision to contain a clear statement of the method of adjustment to be used;
(7) A provision that the insurer shall issue to the policyholder, for
delivery to each person insured, a certificate setting forth a statement as
to the insurance protection to which that person is entitled, to whom the
insurance benefits are payable, and a statement as to any family member's or
dependent's coverage;
(8) A provision that 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. Failure to give notice within such time shall not
invalidate nor reduce any claim if it shall be shown not to have been
reasonably possible to give such notice and that notice was given as soon as
was reasonably possible;
(9) A provision that the insurer shall furnish to the person making
claim, or to the policyholder for delivery to such person, such forms as are
usually furnished by it for filing proof of loss. If such forms are not
furnished before the expiration of fifteen days after the insurer receives
notice of any claim under the policy, the person making such claim 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;
(10) A provision that in the case of claim for loss of time for
disability, written proof of such loss must be furnished to the insurer
within ninety days after the commencement of the period for which the insurer
is liable, and that subsequent written proofs of the continuance of such
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 such loss must be furnished to the insurer within ninety
days after the date of such loss. Failure to furnish such proof within such
time shall not invalidate nor reduce any claim if it was not reasonably
possible to furnish such proof within such time, provided such proof is
furnished as soon as reasonably possible and in no event, except in the
absence of legal capacity of the claimant, later than one year from the time
proof is otherwise required;
(11) A provision that all benefits payable under the policy other than
benefits for loss of time shall be payable not more than thirty days after
receipt of proof and that, subject to due proof of loss, all accrued benefits
payable under the policy for loss of time shall be paid not less frequently
than monthly during the continuance of the period for which the insurer is
liable, and that any balance remaining unpaid at the termination of such
period shall be paid as soon as possible after receipt of such proof;
(12) A provision that benefits for accidental loss of life of a person
insured shall be 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. In either
case, payment of these benefits is subject to the provisions of the policy in
the event no such designated or specified beneficiary is living at the death
of the person insured. All other benefits of the policy shall be payable to
the person insured. The policy may also 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 such benefit, up
to an amount not exceeding two thousand dollars, to any relative by blood or
connection by marriage of such person who is deemed by the insurer to be
equitably entitled thereto;
(13) A provision that the insurer shall have the right and opportunity,
at the insurer's own expense, to examine the person of the individual for
whom claim is made when and so often as it may reasonably require during the
pendency of the claim under the policy and also the right and opportunity, at
the insurer's own expense, to make an autopsy in case of death where it is
not prohibited by law;
(14) A provision that no action at law or in equity shall be brought to
recover on the policy prior to the expiration of sixty days after proof of
loss has been filed in accordance with the requirements of the policy and
that no such action shall be brought at all unless brought within three years
from the expiration of the time within which proof of loss is required by the
policy;
(15) A provision specifying the conditions under which the policy may be
terminated. Such provision shall state that except for nonpayment of the
required premium or the failure to meet continued underwriting standards, the
insurer may not terminate the policy prior to the first anniversary date of
the effective date of the policy as specified therein, and a notice of any
intention to terminate the policy by the insurer must be given to the
policyholder at least thirty-one days prior to the effective date of the
termination. Any termination by the insurer shall be without prejudice to any
expenses originating prior to the effective date of termination. An expense
will be considered incurred on the date the medical care or supply is
received;
(16) A provision stating that if a policy provides that coverage of a
dependent child terminates upon attainment of the limiting age for dependent
children specified in the policy, such policy, so long as it remains in
force, shall be deemed to provide that attainment of such limiting age does
not operate to terminate the hospital and medical coverage of such child
while the child is and continues to be both incapable of self-sustaining
employment by reason of mental or physical handicap and chiefly dependent
upon the certificate holder for support and maintenance. Proof of such
incapacity and dependency must be furnished to the insurer by the certificate
holder at least thirty-one days after the child's attainment of the limiting
age. The insurer may require at reasonable intervals during the two years
following the child's attainment of the limiting age subsequent proof of the
child's incapacity and dependency. After such two-year period, the insurer
may require subsequent proof not more than once each year. This subdivision
shall apply only to policies delivered or issued for delivery in this state
on or after one hundred twenty days after September 28, 1985;
(17) A provision stating that if a policy provides that coverage of a
dependent child terminates upon attainment of the limiting age for dependent
children specified in the policy, such policy, so long as it remains in
force, until the dependent child attains the limiting age, shall remain in
force at the option of the certificate holder. Eligibility for continued
coverage shall be established where the dependent child is:
(a) Unmarried and no more than that twenty-five years of age; and
(b) A resident of this state; and
(c) Not provided coverage as a named subscriber, insured, enrollee, or
covered person under any group or individual health benefit plan, or entitled
to benefits under Title XVIII of the Social Security Act, P.L. 89-97, 42
U.S.C. Section 1395, et seq.;
(18) In the case of a policy insuring debtors, a provision that the
insurer shall furnish to 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.
1991
376.426. No policy of group health insurance shall be
delivered in this state unless it contains in substance the
following provisions, or provisions which in the opinion of the
director of insurance are more favorable to the persons insured
or at least as favorable to the persons insured and more
favorable to the policyholder; except that: Provisions in
subdivisions (5), (7), (12), (15), and (16) of this section shall
not apply to policies insuring debtors; standard provisions
required for individual health insurance policies shall not apply
to group health insurance policies; and if any provision of this
section is in whole or in part inapplicable to or inconsistent
with the coverage provided by a particular form of policy, the
insurer, with the approval of the director, shall omit from such
policy any inapplicable provision or part of a provision, and
shall modify any inconsistent provision or part of the provision
in such manner as to make the provision as contained in the
policy consistent with the coverage provided by the policy:
(1) A provision that the policyholder is entitled to a grace
period of thirty-one days for the payment of any premium due
except the first, during which grace period the policy shall
continue in force, unless the policyholder shall have given 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 shall be liable to
the insurer for the payment of a pro rata premium for the time
the policy was in force during such grace period;
(2) A provision that the validity of the policy shall not be
contested, except for nonpayment of premiums, after it has been
in force for two years from its date of issue, and that 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 such statement was made after
such insurance has been in force prior to the contest for a
period of two years during such person's lifetime nor unless it
is contained in a written instrument signed by the person making
such statement; except that, no such provision shall preclude the
assertion at any time of defenses based upon the person's
ineligibility for coverage under the policy or upon other
provisions in the policy;
(3) A provision that a copy of the application, if any, of
the policyholder shall be attached to the policy when issued,
that all statements made by the policyholder or by the persons
insured shall be deemed representations and not warranties and
that 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 such person or, in the event of the
death or incapacity of the insured person, to the individual's
beneficiary or personal representative;
(4) A provision setting forth the conditions, if any, under
which the insurer reserves the right to require a person eligible
for insurance to furnish evidence of individual insurability
satisfactory to the insurer as a condition to part or all of the
individual's coverage;
(5) A provision specifying the additional exclusions or
limitations, if any, applicable under the policy with respect to
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. Any such exclusion or limitation may only
apply to a disease or physical condition for which medical advice
or treatment was received by the person during the twelve months
prior to the effective date of the person's coverage. In no
event shall such exclusion or limitation apply to loss incurred
or disability commencing after the earlier of:
(a) The end of a continuous period of twelve months
commencing on or after the effective date of the person's
coverage during all of which the person has received no medical
advice or treatment in connection with such disease or physical
condition; or
(b) The end of the two-year period commencing on the
effective date of the person's coverage;
(6) If the premiums or benefits vary by age, there shall be
a provision specifying an equitable adjustment of premiums or of
benefits, or both, to be made in the event the age of the covered
person has been misstated, such provision to contain a clear
statement of the method of adjustment to be used;
(7) A provision that the insurer shall issue to the
policyholder, for delivery to each person insured, a certificate
setting forth a statement as to the insurance protection to which
that person is entitled, to whom the insurance benefits are
payable, and a statement as to any family member's or dependent's
coverage;
(8) A provision that 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. Failure to give
notice within such time shall not invalidate nor reduce any claim
if it shall be shown not to have been reasonably possible to give
such notice and that notice was given as soon as was reasonably
possible;
(9) A provision that the insurer shall furnish to the person
making claim, or to the policyholder for delivery to such person,
such forms as are usually furnished by it for filing proof of
loss. If such forms are not furnished before the expiration of
fifteen days after the insurer receives notice of any claim under
the policy, the person making such claim 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;
(10) A provision that in the case of claim for loss of time
for disability, written proof of such loss must be furnished to
the insurer within ninety days after the commencement of the
period for which the insurer is liable, and that subsequent
written proofs of the continuance of such 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 such loss must be furnished to the insurer
within ninety days after the date of such loss. Failure to
furnish such proof within such time shall not invalidate nor
reduce any claim if it was not reasonably possible to furnish
such proof within such time, provided such proof is furnished as
soon as reasonably possible and in no event, except in the
absence of legal capacity of the claimant, later than one year
from the time proof is otherwise required;
(11) A provision that all benefits payable under the policy
other than benefits for loss of time shall be payable not more
than thirty days after receipt of proof and that, subject to due
proof of loss, all accrued benefits payable under the policy for
loss of time shall be paid not less frequently than monthly
during the continuance of the period for which the insurer is
liable, and that any balance remaining unpaid at the termination
of such period shall be paid as soon as possible after receipt of
such proof;
(12) A provision that benefits for accidental loss of life
of a person insured shall be 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. In either case,
payment of these benefits is subject to the provisions of the
policy in the event no such designated or specified beneficiary
is living at the death of the person insured. All other benefits
of the policy shall be payable to the person insured. The policy
may also 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 such
benefit, up to an amount not exceeding two thousand dollars, to
any relative by blood or connection by marriage of such person
who is deemed by the insurer to be equitably entitled thereto;
(13) A provision that the insurer shall have the right and
opportunity, at the insurer's own expense, to examine the person
of the individual for whom claim is made when and so often as it
may reasonably require during the pendency of the claim under the
policy and also the right and opportunity, at the insurer's own
expense, to make an autopsy in case of death where it is not
prohibited by law;
(14) A provision that no action at law or in equity shall be
brought to recover on the policy prior to the expiration of sixty
days after proof of loss has been filed in accordance with the
requirements of the policy and that no such action shall be
brought at all unless brought within three years from the
expiration of the time within which proof of loss is required by
the policy;
(15) A provision specifying the conditions under which the
policy may be terminated. Such provision shall state that except
for nonpayment of the required premium or the failure to meet
continued underwriting standards, the insurer may not terminate
the policy prior to the first anniversary date of the effective
date of the policy as specified therein, and a notice of any
intention to terminate the policy by the insurer must be given to
the policyholder at least thirty-one days prior to the effective
date of the termination. Any termination by the insurer shall be
without prejudice to any expenses originating prior to the
effective date of termination. An expense will be considered
incurred on the date the medical care or supply is received;
(16) A provision stating that if a policy provides that
coverage of a dependent child terminates upon attainment of the
limiting age for dependent children specified in the policy, such
policy, so long as it remains in force, shall be deemed to
provide that attainment of such limiting age does not operate to
terminate the hospital and medical coverage of such child while
the child is and continues to be both incapable of
self-sustaining employment by reason of mental or physical
handicap and chiefly dependent upon the policyholder for support
and maintenance. Proof of such incapacity and dependency must be
furnished to the insurer by the policyholder at least thirty-one
days before the child's attainment of the limiting age. The
insurer may require at reasonable intervals during the two years
following the child's attainment of the limiting age subsequent
proof of the child's incapacity and dependency. After such
two-year period, the insurer may require subsequent proof not
more than once each year. This subdivision shall apply only to
policies delivered or issued for delivery in this state on or
after one hundred twenty days after September 28, 1985;
(17) In the case of a policy insuring debtors, a provision
that the insurer shall furnish to 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.
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Missouri General Assembly
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