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054.00.32-11. INFORMATION REQUESTED BY INSURER

AR ADC 054.00.32-11Arkansas Administrative Code

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule 32. Minimum Standards for Individual Policies or Certificates Issued upon Conversion from a Group Disability Insurance Policy
Ark. Admin. Code 054.00.32-11
054.00.32-11. INFORMATION REQUESTED BY INSURER
Currentness
A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of such policy of any person covered thereunder as to whether
(i) he is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program,
(ii) he is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis, or
(iii) similar benefits are provided for or available to such person, pursuant to or in accordance with the requirements of any state or federal law. The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured thereunder the following reasons only:
(a) either the benefits provided under the sources referred to in (i) and (ii) above for such person, or benefits provided or available under the sources referred to in (iii) above for such person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards on file with the Commissioner of Insurance, or the converted policyholder fails to provide the request information;
(b) fraud or material misrepresentation in applying for any benefits under the converted policy;
(c) eligibility of the insured person for coverage under Medicare (Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded) or under any other state or federal law providing for benefits similar to those provided by the converted policy;
(d) other reasons approved by the Commissioner of Insurance.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.32-11, AR ADC 054.00.32-11
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