2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 18 - Group and Blanket Health Insurance 18.18-070 Filing and required provisions in blanket policies.
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304.18-070 Filing and required provisions in blanket policies.
Any insurer authorized to write health insurance in this state shall have the power to
issue blanket health insurance. No such blanket policy, except as provided in
subsection (4) of KRS 304.14-120, may be issued or delivered in this state unless a
copy of the form thereof has been filed in accordance with KRS 304.14-120. Every
such blanket policy shall contain provisions which in the opinion of the commissioner
are not less favorable to the policyholder and the individual insured than the
following:
(1) A provision that the policy, including indorsements and a copy of the
application, if any, of the policyholder and the persons insured shall constitute
the entire contract between the parties, and that any statement made by the
policyholder or by a person insured shall in the absence of fraud be deemed a
representation and not a warranty, and that no such statements shall be used
in defense to a claim under the policy, unless contained in a written application.
Such person, his or her beneficiary or assignee shall have the right to make a
written request to the insurer for a copy of such application, and the insurer
shall within fifteen (15) days after the receipt of such request at its principal
office or any branch office of the insurer, deliver or mail to the person making
such request a copy of such application. If such copy is not so delivered or
mailed, the insurer shall be precluded from introducing such application as
evidence in any action based upon or involving any statements contained
therein;
(2) A provision that written notice of sickness or of injury must be given to the
insurer within twenty (20) days after the date when such sickness or injury
occurred. Failure to give notice within such time shall not invalidate or reduce
any claim if it is shown not to have been reasonably possible to give such
notice and that notice was given as soon as was reasonably possible;
(3) A provision that the insurer will furnish either to the claimant or to the
policyholder for delivery to the claimant such forms as are usually furnished by
it for filing proof of loss. If such forms are not furnished before the expiration of
fifteen (15) days after giving such 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, the character and the extent of the loss for which
claim is made;
(4) A provision that in the case of a claim for loss of time for disability, written proof
of such loss must be furnished to the insurer within ninety (90) 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 a claim for any other loss, written proof of such loss
must be furnished to the insurer within ninety (90) days after the date of such
loss. Failure to furnish such proof within such time shall not invalidate or reduce
any claim if it is shown not to have been reasonably possible to furnish such
proof and that such proof was furnished as soon as was reasonably possible;
(5) A provision that all benefits payable under the policy other than benefits for
loss of time will be payable immediately upon receipt of due written proof of
(6)
(7)
such loss, and that, subject to due proof of loss, all accrued benefits payable
under the policy for loss of time will 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 will be paid
immediately upon receipt of such proof;
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 claim under the policy and also the
right and opportunity to make an autopsy where it is not prohibited by law; and
A provision that no action at law or in equity shall be brought to recover under
the policy prior to the expiration of sixty (60) days after written proof of loss has
been furnished in accordance with the requirements of the policy and that no
such action shall be brought after the expiration of three (3) years after the time
written proof of loss is required to be furnished.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1294, effective July 15, 2010. -Created 1970 Ky. Acts ch. 301, subtit. 18, sec. 7, effective June 18, 1970.
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