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Regulation Of The Safe's Group For The Operation Of Life And Of The Secure Collective For The Operation Of Accidents And Diseases

Original Language Title: Reglamento del Seguro de Grupo para la Operación de Vida y del Seguro Colectivo para la Operación de Accidentes y Enfermedades

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SECRETARIAT OF FINANCE AND PUBLIC CREDIT

SECRETARY OF FINANCE AND PUBLIC CREDIT

Group Insurance Regulation for Operation of Life and Collective Insurance for the Operation of Accidents and Diseases.

On the sidelines a seal with the National Shield, which reads: United Mexican States.-Presidency of the Republic.

FELIPE DE JESÚS CALDERÓN HINOJOSA, President of the United Mexican States, exercising the power conferred on me by Article 89, fraction I of the Political Constitution of the United States Mexicans and based on the provisions of the articles 1o., 12, 36-C and 36-D of the General Law of Mutual Institutions and Societies of Insurance; 24, 188 and 191 of the Law on the Contract of Insurance, and 31 of the Organic Law of the Federal Public Administration, I have had to issue the following:

GROUP INSURANCE REGULATION FOR LIFE OPERATION AND COLLECTIVE INSURANCE FOR THE OPERATION OF ACCIDENTS AND DISEASES

Article 1.- For the holding of group or company insurance, as well as the collective insurance provided for in Articles 188 and 191 of the Insurance Contract Act, institutions and companies mutualists shall be governed by the provisions of the General Law on Mutual Insurance Institutions and Societies, the Law on the Insurance Contract and this Regulation.

Article 2.- For the purposes of this Regulation:

I.         Insurer, to the institutions or mutual insurance companies authorized in accordance with the General Law of Insurance Institutions and Mutual Societies;

II.        Certificate, to individual group or collective insurance certificates;

III.       Commission, to the National Insurance and Fiances Commission;

IV.      Contractor, to the natural or moral person who holds the Group Insurance or Collective Insurance contract with an Assurance;

V.       Dividends, to the amount corresponding to the Contracting Party or to the insured, in the latter case when participating in the payment of the premium, in policies with profit participation by profits made;

VI.      Group or Collective, to any group of persons belonging to the same undertaking or who maintain a common interest or link that is lawful, prior and independent to the conclusion of the insurance contract;

VII.     Member, any person who is part of the Group or Collective;

VIII.    Secretary, to the Secretariat of Finance and Public Credit;

IX.      Group, the insurance contract for which the purpose is to secure a group or collective against risks inherent in the life operation provided for in Articles 7o, part I and 8o., part I of the General Law of the Institutions and Mutual Insurance Companies, and

X.       Collective Insurance, to the insurance contract for which the purpose is to ensure a group or collective against risks inherent in the operation of accidents and diseases referred to in Articles 7o, II and 8, fractions III, IV and V of the General Law of Insurance Institutions and Mutual Societies.

The meanings assigned to the terms defined in this article will apply, in the same way, to their singular or plural form.

Article 3.- The Secretariat in the exercise of its legal powers, may interpret and resolve for administrative purposes the provisions of this Regulation.

Article 4.- The Commission may, in the terms of the applicable rules, issue general provisions on the insurance of Group and Collective Insurance for the protection of the interests of the contractors, policyholders and beneficiaries.

Article 5.- In the technical notes relating to the Group Insurance and Collective Insurance products that the Insurers register in terms of the provisions of the General Law of Institutions and Mutual Insurance Companies, must point out the technical principles and procedures that they will use to avoid adverse selection phenomena for the insurer.

Article 6.- The total premium of the Group or Collective, as well as the premiums that correspond to each member of the group will be obtained according to the respective technical note and the Contractor will be responsible for making the payment.

On each expiration date of the contract, the insurer will be able to calculate the average premium that will be applied to the renewal.

The calculation of the fee premium for the new Members of the Group or the Collective, as well as those that cease to be part of the same, will be subject to the rules techniques and operations established by the Assurance for the case, in the corresponding insurance product.

Article 7.- Dealing with the Integrants of a Group or Collective, as insured, may contribute to the payment of the premium in terms of the policy.

Article 8.- The granting of favorable claims in Group Insurance and Collective Insurance will be subject to the following:

I. The Dividends that, if any, will be awarded, will be calculated by considering the Group's Own Experience or Collective Experience, or the Global Experience of the Assurance in question, which is justify in the respective technical note at the time of registration of the Group Insurance or Collective Insurance product.

the following definitions shall apply:

a) Own experience, when the premium of the Group or Collective is determined based on the experience of claims of the same or the Group Insurance or Collective Insurance policies that belong to the same business group.

For life insurance, the number of Members of the Group or Collective may not be less than one thousand at the beginning of the term of the contract.

In the case of accident and disease insurance, the minimum number of Members of the Group or Collective shall permit the application of actuarial procedures, in such a way that the assumptions made in the calculation of the premium have a reasonable degree of reliability. Only constituted Groups or Collectivities may be integrated when they belong to the same business group and, as a whole, comply with the provisions of Article 2 (V) of this Regulation, and

b) Global Experience, when the Group or Collective premium is not determined based on your Own Experience;

II. The granting of Dividends must be expressly agreed upon in the policy at the time of their hiring;

III. Dividends may only be calculated based on the utility resulting from the difference between net risk premiums written and claims occurring. The net risk premium for the calculation of the dividends shall be determined on the basis of the procedure that the insurer establishes in the technical note to the Commission. In the case of Global Experience, the Dividends shall be determined using the total experience of the portfolio of the insurer concerned.

For the purposes of the calculation of Dividends to be granted in Group Insurance, it may be considered up to the amount of the premium corresponding to the maximum insured sum that is established to be granted without medical requirements, excluding from the calculation of Dividends all those premiums paid for the surplus to that sum. In this case, the principle laid down in the fourth paragraph of this Article shall be maintained as regards the premium paid in respect of the sum insured as a basis for the calculation of the dividends;

IV. When policyholders participate in the premium payment, they will be entitled to receive the Dividends that are generated in proportion to the contributions they have made;

V. The determination of the Dividends to be paid shall be made in accordance with the following:

a) In case of Own Experience, at the end of the policy term;

b) In case of Global Experience, at the end of the corresponding fiscal year, and

c) In the case of multi-year policies, the Dividends may be determined on the anniversary of the policy.

The calculation of the dividends to be paid shall be made on the dates specified in the preceding points, irrespective of the dates on which the calculation of the Dividends is carried out for the constitution of corresponding technical reserves;

VI.      Only dividends calculated as set out in the preceding fractions I to V may be paid;

VII.     Dividends cannot be paid before the end of the policy. No anticipated or guaranteed dividends may be paid. Advance payments shall be understood to mean making payments based on the utility calculated before the end of the policy period. In the case of policies whose validity is less than one year, no Dividends can be granted;

VIII.    In multi-year policies, the payment of Dividends must be annual, to the anniversary of the policy, and

IX.      Any agreement concerning the compensation of claims that have occurred and not been reported during the duration of the policy against paid dividends, must be established in the contract documentation.

Article 9.- The Insurers will be able to provide Dividends for utility in financial returns. Such dividends may only be calculated on the basis of the usefulness resulting from the difference between the yield obtained by the investments supporting the technical reserves and the expected rate of return contained in the respective technical note. The procedure for calculating these Dividends shall be provided in the technical note at the time of registration of the Group Insurance or Collective Insurance product.

The payment of dividends for use in financial returns shall be subject to the principles set out in Article 8 of this Regulation.

Article 10.- The request format that the Assurance provides to celebrate the Group Insurance and Collective Insurance contract must include the following information:

I. Insurance operation in question and nature of the risk to be secured;

II. Number, age and gender, of the insured persons under the insurance contract;

III. Particular or special features of the Group or Collective to be secured, as well as your relationship with the Contractor;

IV. Assured for Group Integrants or Collective or Rule to determine;

V. Participation with which, if any, the Members of the Group or Collective will contribute to the payment of the premium;

VI. Statement on the existence of circumstances that are considered to be decisive for assessing the possibility of losses arising from the simultaneous occurrence of claims Members of the Group or Collective, directly caused by the activity performed by them;

VII. When the object of the Group Insurance or Collective Insurance contract is to guarantee benefits or obligations under the same Contracting Party, this circumstance must be expressed in the request, and

VIII. Other than, where appropriate, the Commission considers necessary to comply with this Regulation.

Article 11.- In the case of Group Insurance that covers the risk of death, the Insurers must have the written consent of each of the Members, prior to their incorporation into the Group, prior to the conclusion of the contract, which shall contain at least the following:

I.         Sum assured or rule to determine, and

II.        Designation of beneficiaries and whether this is done irrevocably.

Article 12.- Trating to Group Insurance the Contracting Party may not be designated a beneficiary unless the subject of the insurance contract is:

I.         To guarantee credits granted by this, or legal, voluntary or contractual benefits in charge of it. In the event that the Group Insurance guarantees credits, the Contracting Party may only be eligible for the corresponding insolute balance;

II.        Guarantee the payment of the registration or tuition, in the case of school or educational insurance, or

III.       Reside to the Contracting of the decrease that in their productivity could cause death, accident or illness of technicians or leaders.

Article 13.- The insurer will form an insured record in each Group Insurance and in each Collective Insurance, which must have the following information:

I. Name, age or date of birth and sex, of each Member of the Group or Collective;

II. Assured sum or rule to determine;

III.       The date of entry into force of the insurance of each of the Integrants and the date of termination of the insurance;

IV. Operation and insurance plan in question;

V. Individual Certificate Number, and

VI. Amstops covers.

The Commission may authorise, by means of general provisions, that the insurers may optionally use data that also allows them to integrate such information.

At the request of the Contracting Party, the Insurance Holder must submit a copy of this record.

Article 14.- In addition to the requirements corresponding to the provisions of Article 153 of the Law on the Insurance Contract, in the contractual documentation by which the Insurance formalize Group Insurance and Collective Insurance must include the following information:

I. The characteristics of the secured Group or Collective;

II. The rate premium or rule to determine for each Group member or Collective, and share with which, if applicable, contribute to the payment of the premium;

III. Assured for Group Integrants or Collective or Rule to determine them;

IV. Where applicable, the mechanism that the insurer will use for the payment of dividends to the contractor and, if applicable, to the insured of the Group or Collective, and

V. The transcript of the text that is applicable from Articles 17 to 21 of this Regulation.

Article 15.- In the Group Insurance and Collective Insurance contracts, the obligation of the Contracting Party to give notice or to send periodic information to the insurer must be established in respect of the following, as well as the procedure by which the Contracting Party shall comply with that obligation:

I. The entry into the Group or Collective of new members, including the respective consents for the case of insurance covering the death, as well as the information indicated in Section VII of Article 10 of this Regulation;

II. The definitive separation of Integrants from the Group or Secured Collective;

III. Any changes to the situation of policyholders that affect the conditions of risk or the application of the rules to determine insured sums, and

IV. The new consents of insured persons covered by the risk of death, in case of modification of the rules for the determination of the insured sums, pointing out the form in to be administered.

Article 16.- The insurer must issue and deliver a Certificate for each of the Members of the Group or Secured Collective, adhering to the following:

I. Certificates must contain the following information:

a) Name, telephone, and address of the insurer;

b) Signature of the Authoriser's authorized official;

c) Insurance operation, policy number, and certificate number;

d) Name of the Contractor;

e) Name and date of birth or age reached of the insured;

f) Policy and Certificate Effective Date;

g) Assured sum or rules to determine for each benefit;

h) Name of the beneficiaries and, where appropriate, the irrevocable character of the designation;

(i) Transcription corresponding to, according to the type of insurance concerned, the text of Articles 17 and 18 of this Regulation, and

(j) In the case of Group and Insurance Collective insurance which is intended to provide an employment benefit, it must be transcribed, as appropriate according to the insurance in question, Article 19 of this Regulation.

II. The Assurance, prior agreement with the Contracting Party, may comply with the obligation to deliver the Certificates as follows:

a) Providing the Contractor with the Certificates for delivery to the policyholders, or

b) Establishing the obligation of the Contracting Party to make the information provided for in part I of this article aware of the policyholders.

In all cases, the insured person may apply to the insurer for the corresponding Certificate.

Article 17.- Persons entering the Group or Collective insured after the conclusion of the contract and who have given their consent to be insured within thirty days natural following their income, they will be insured under the same conditions under which the policy was contracted, from the moment they acquired the characteristics to be part of the Group or Collective in question.

Regardless of what is foreseen in the previous paragraph, in the case of persons applying for membership of the Group or Secured Collective after the conclusion of the contract and who have given their consent after the thirty calendar days following the date on which they acquired the right to be a part of it, the insurer, within thirty calendar days of the date on which they were notified of that date. situation, you may require medical or other requirements to secure them, if you do not insured under the same conditions as the policy was contracted.

When the insurer requires medical or other requirements to assure the persons referred to in the preceding paragraph, it shall have a period of thirty calendar days, counted from the date on which it is have fulfilled those requirements to resolve the acceptance or not to assure the person, if not to be understood that he accepts it with the same conditions in which the policy was contracted.

Article 18.- Persons who are permanently separated from the Group or Secured Collective shall cease to be insured from the time of their separation, with no validity of the Certificate individual issued. In this case, the insurer shall repay the part of the net non-accrual premium of such an integrant calculated on exact days, to whom it has contributed, in the corresponding proportion.

Article 19.- In Group Insurance and in Collective Insurance the object of which is to grant an employment benefit, the following must be met:

I. For the life operation, the insurer will have the obligation to ensure, for a single time and without medical requirements, to the Group Integrant or Collective that it is definitively separated from the in any of the individual plans of the life operation which it is placing on the market, with the exception of temporary insurance and not including any additional benefit, provided that its age is within the limits of the admission of the Insurer. In order to exercise this right, the person separated from the Group or Collective must submit his or her application to the insurer within 30 calendar days of their separation. The sum insured shall be the lowest between the one in force at the time of the separation and the maximum sum insured without medical tests of the individual portfolio of the insurer, considering the age of the insured person at the time to be separated. The premium shall be determined in accordance with the procedures laid down in the technical notes registered with the Commission. The applicant shall pay the insurer the premium corresponding to the age reached and occupation, if any, on the date of his application, according to the tariff in force. Insurers who practice Group Insurance in the life operation shall operate at least one ordinary life plan.

II. In the operation of accidents and diseases, the insurer may agree to the right of conversion to an individual policy for the Members of the Group or Collective that are separated from definitive manner of the same, pointing out its characteristics.

Article 20.- For the case of Group Insurance and Collective Insurance, the object of which is to grant an employment benefit, when there is a change of Contracting the insurer may:

I.         Dealing with Group Insurance, terminate the contract or reject the inclusion of new Integrants to the Group or Collective, within thirty calendar days of the date on which you are aware of the change. Their obligations will end thirty calendar days after the termination of the new Contracting Party has been notified.

II.        Dealing with Collective Insurance, terminate the contract or reject the inclusion of new Integrants to the Group or Collective, within thirty calendar days of the date on which you are aware of the change. In this case, their obligations shall end at 12 hours on the day after the termination of the contract has been notified in a manner that is true to the new Contracting Party.

In any event, the insurer will reimburse those who have provided the premium, in a proportional manner, the net non-accrual premium and, if any, the benefits derived from that contract, adhering to the in Articles 7 and 8 of this Regulation.

Article 21.- The insurer may renew the Group Insurance and Collective Insurance contracts when the temporality is one year or less, by endorsement of the policy in the same the conditions under which they were contracted, provided that the requirements of this Regulation are met on the date of expiry of the contract. Each renewal shall apply the rate premiums obtained in accordance with the procedures registered with the Commission in the respective technical notes.

Article 22.- The insurer shall be required to compile and maintain an updated file with the information referred to in this Regulation relating to Group and Group Insurance policies. Collective Insurance that you issue.

Article 23.- In cases where the insurer and the contractor have agreed that the administration of the policy will be carried out by the latter, it must be established in the contract the insurer will have access to the relevant information, for the purpose of complying in time and form with the provisions of this Regulation, as well as with the information requirements established by the Commission in respect of these insurance, in accordance with applicable legal provisions and this Regulation.

Article 24.- The Insurers must provide the information required by the National Commission for the Protection and Defense of Financial Services Users, so that the latter can deliver the information referred to in the last two paragraphs of Article 52 of the Protection and Defense Act to the Financial Services User.

TRANSIENT

First.- This Regulation shall enter into force on the one hundred and eighty calendar days following the date of its publication in the Official Journal of the Federation.

Second.- For purposes of this Regulation, Group Insurance will refer to both group insurance and collective insurance in the life operation that were previously issued to the entry in force of this Regulation.

Third.- For the purposes of this Regulation, Collective Insurance will refer to both group insurance and collective insurance in the operation of accidents and diseases that have been issued with prior to the entry into force of this Regulation.

Fourth.- The Group Insurance Regulation published in the Official Journal of the Federation of July 7, 1962 is repealed.

Fifth.- The repealed Regulation will remain in force for the sole effect of applying the sanctions provided for in the General Law of Mutual Insurance Institutions and Societies, to those Insurers that they have not given due respect to it and that the administrative procedures resulting from its failure to comply are continued until its conclusion.

Sixth.- The administrative provisions issued on the basis of the Group Insurance Regulation published in the Official Journal of the Federation of July 7, 1962, will continue to apply. where they do not object to the provisions of this Regulation.

Given at the Federal Executive Branch, in Mexico City, Federal District, on 15 July, two thousand nine.- Felipe de Jesús Calderón Hinojosa.-Heading.-The Secretary of Finance and Public Credit, Agustin Guillermo Carstens Carstens.-Heading.