Section 376.438

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 1999   

  376.438.  Group policies, modifying or amending benefits shall provide extension of benefits in event of total disability at date of termination or discontinuance. — 1.  Every group policy or other contract subject to sections 376.431 to 376.442, or under which the level of benefits is hereafter altered, modified or amended, must provide a reasonable provision for extension of benefits in the event of total disability at the date of any termination or discontinuance of the group policy or contract, regardless of the reason for the termination or discontinuance, as required by the following subdivisions of this subsection:

  (1)  In the case of a group life plan which contains a disability benefit extension of any type, such as premium waiver extension, extended death benefit in event of total disability, or payment of income for a specified period during total disability, the discontinuance of the group policy shall not operate to terminate such extension;

  (2)  In the case of a group plan providing benefits for loss of time from work or specific indemnity during hospital confinement, discontinuance of the policy during a disability shall have no effect on benefits payable for that disability or confinement;

  (3)  In the case of health maintenance organization, hospital or medical expense coverages other than dental and maternity expense, a reasonable extension of benefits or accrued liability provision is required.  Such a provision will be considered reasonable if it provides an extension of at least twelve months under health maintenance organization, major medical and comprehensive medical type coverages, and under other types of hospital or medical expense coverages provides either an extension of at least ninety days or an accrued liability for expenses incurred during a period of disability or during a period of at least ninety days starting with a specific event which occurred while coverage was in force.

  2.  Any applicable extension of benefits or accrued liability shall be described in any policy or contract involved as well as in insurance certificates of coverage issued to employees or members.  The benefits payable during any period of extension or accrued liability may be subject to the policy's or contract's regular benefit limits.

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(L. 1985 H.B. 623, A.L. 1999 H.B. 903)