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Session Laws, 1999
Volume 796, Page 1658   View pdf image
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(II) 12 MONTHS AFTER THE DATE COVERAGE TERMINATES.

(3) AN ENTITY SUBJECT TO THIS SUBSECTION MAY AT ANY TIME
REQUIRE THE INDIVIDUAL TO PROVIDE PROOF OF TOTAL DISABILITY.

(F) (1) THIS SUBSECTION APPLIES TO:

(I) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT
PROVIDE HOSPITAL, MEDICAL, OR SURGICAL BENEFITS ON AN EXPENSE-INCURRED
BASIS UNDER INDIVIDUAL HEALTH INSURANCE POLICIES THAT ARE ISSUED OR
DELIVERED IN THE STATE; AND

(II) HEALTH MAINTENANCE ORGANIZATIONS THAT PROVIDE
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS UNDER INDIVIDUAL CONTRACTS THAT
ARE ISSUED OR DELIVERED IN THE STATE.

(2) IF AN INDIVIDUAL HAS A CLAIM IN PROGRESS WHEN THE
INDIVIDUAL'S COVERAGE TERMINATES, AN ENTITY SUBJECT TO THIS SUBSECTION
SHALL CONTINUE TO PAY BENEFITS COVERED BENEFITS. IN ACCORDANCE WITH
THE POLICY IN EFFECT AT THE TIME THE INDIVIDUAL'S COVERAGE TERMINATES,
RELATED TO THE CLAIM UNTIL THE EARLIER OF:

(I) THE DATE THE INDIVIDUAL IS RELEASED FROM THE CARE OF A
PHYSICIAN FOR THE CONDITION THAT IS THE BASIS OF THE CLAIM; OR

(II) 12 MONTHS AFTER THE DATE COVERAGE TERMINATES.

(G) (1) THIS SUBSECTION APPLIES TO:

(I) GROUP, BLANKET, AND INDIVIDUAL POLICIES THAT LIMIT
COVERAGE TO HOSPITAL OR SURGICAL BENEFITS ON AN EXPENSE-INCURRED BASIS;
AND

(II) GROUP, BLANKET, AND INDIVIDUAL HOSPITAL INDEMNITY

POLICIES.

(2) IF AN INDIVIDUAL IS CONFINED IN A HOSPITAL ON THE DATE
COVERAGE TERMINATES, A POLICY SUBJECT TO THIS SUBSECTION SHALL CONTINUE
TO PAY BENEFITS COVERED BENEFITS, IN ACCORDANCE WITH THE POLICY IN
EFFECT AT THE TIME THE INDIVIDUAL'S COVERAGE TERMINATES, FOR THE
CONFINEMENT UNTIL THE EARLIER OF:

(I) THE DATE THE INDIVIDUAL IS DISCHARGED FROM THE

HOSPITAL; OR

(II) 12 MONTHS AFTER THE DATE COVERAGE TERMINATES.

(H) (1) THIS SUBSECTION APPLIES TO INSURERS, NONPROFIT HEALTH
SERVICE PLANS, AND HEALTH MAINTENANCE ORGANIZATIONS THAT PROVIDE
GROUP, BLANKET, OR INDIVIDUAL VISION BENEFITS.

(2) IF AN INDIVIDUAL HAS ORDERED GLASSES OR CONTACT LENSES
BEFORE THE DATE COVERAGE TERMINATES, AN ENTITY SUBJECT TO THIS

 

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Session Laws, 1999
Volume 796, Page 1658   View pdf image
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