Section 2243.5 - Policies to Contain Required Provisions and May Contain Optional Provisions; Uniform ProvisionsEvery U. C. D. policy issued or delivered by any insurer shall contain the required provisions hereinafter set forth and many contain the optional provisions hereinafter set forth either in the exact language so set forth or in the substance thereof, or in the substance thereof but more favorable to the employees insured or not less favorable to such employees and more favorable to the employer; provided it shall be presumed, subject to the approval of the commissioner, that the policy contains the substance of the required and optional provisions herein set forth if it contains therein in accordance with the rules and regulations for their use those uniform provisions promulgated for use in group disability policies which cover the same subject matter as the required and optional provisions herein set forth, with such changes in the language of such uniform provisions as are necessary to make them fit the coverage provided in the U. C. D. policy, and meet in substance the corresponding applicable requirements for such provisions as herein set forth; provided further that:
(a) The uniform provisions captioned "Entire Contract; Changes," "Notice of Claim," "Claims Forms," "Proofs of Loss" and "Time of Payment of Claim" are the uniform provisions which incorporate the substance of the corresponding required provisions for U.C.D. policies herein set forth.(b) The uniform provisions captioned "Physical Examination and Autopsy," "Legal Actions," "Cancellation" and "Payment of Claims" are the uniform provisions which incorporate the substance of the corresponding optional provisions herein set forth for use in U.C.D. policies.(c) In case the uniform provision captioned "Entire Contract; Changes" is used in a U.C.D. policy, there shall be added to the language thereof promulgated for use in group disability policies a phrase reading in substance, "and the provisions of the California Unemployment Insurance Code and the regulations of the Director of the Department of Employment Development which are incorporated by reference in this policy." This phrase shall be added to the enumeration of the writings which constitute the entire contract between the parties, and shall be used in accordance with the requirements set forth in Section 2244.1 hereof.(d) In the blank in the uniform provision captioned "Time of Payment of Claim" there shall be entered either a period of time not greater than one week, or a period of time greater than one week, together with the phrase "or each week if the claimant so requests."(e) To the uniform provision captioned "Physical Examination and Autopsy" there shall be added the phrase "except where such right is limited by the California Unemployment Insurance Code."(f) To the uniform provision captioned "Legal Actions" there shall be added a sentence reading "This provision does not affect in any way any employee's rights to appeal under the California Unemployment Insurance Code."(g) The uniform provisions captioned "Other Insurance in This Insurer," "Time Limits on Certain Defenses," "Change of Beneficiary," "Insurance With Other Insurers," "Illegal Occupations" and "Intoxicants and Narcotics" may not be used in a U. C. D. policy; but this prohibition is without prejudice to the right of the insurer to include in a U. C. D. policy any provision expressly permitted by these rules and regulations, by the regulations of the director or by the C. U. I. Code.(h) The other uniform provisions which neither cover subject matter of required or optional provisions set forth herein nor are forbidden to be used in U. C. D. policies by the immediately preceding paragraph hereof may, subject to the approval of the commissioner and insofar as consistent with the C. U. I. Code, be used in substance in a U. C. D. policy at the option of the insurer.Cal. Code Regs. Tit. 10, § 2243.5
1. Amendment filed 5-6-77 as procedural and organizational; effective upon filing (Register 77, No. 19). Note: Authority cited: Section 10270.2, Insurance Code. Reference: Section 10270.2 (f), Insurance Code.
1. Amendment filed 5-6-77 as procedural and organizational; effective upon filing (Register 77, No. 19).