California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 2a - Group Disability Policies
Subarticle 3 - Optional Uniform Provisions
Section 2232.34 - Insurance with Other Insurers
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
Form A.
Reduced Hospital Benefits in Case of Coverage Under the California Unemployment Insurance Code. The hospital benefits otherwise payable to insured employees hereunder shall be reduced by the amounts of additional benefits during hospital confinement to which such employees shall become entitled pursuant to the California Unemployment Insurance Code or any voluntary plan approved thereunder which is specifically identified in this policy or in the application therefor or in a rider attached to this policy specifically referring to this provision, as such plan is constituted on the effective date of this policy or such rider, as the case may be.
Instructions for Use of Form A
1. The insurer may use this provision only in a policy providing hospital benefits.
2. In lieu of incorporating this uniform provision in the policy, the insurer may, at its option, incorporate the substance or effect thereof, or a provision more favorable to insured employees, in the statement of hospital benefits of the policy by way of an affirmative statement of the benefits applicable to those employees who are also entitled to additional benefits during hospital confinement under the California Unemployment Insurance Code or an existing voluntary plan proved pursuant thereto, or applicable to a period of time for which such additional benefits are payable, or to both. Such affirmative statement of benefits may specifically eliminate or reduce hospital benefits because, or by the amount of the benefits on account of hospitalization to which the employee is entitled as state plan benefits under the California Unemployment Insurance Code to make such equitable adjustment of premium and premium rate for the policy as will after giving effect to the changes in the benefits of the policy resulting from the amendments of the California Unemployment Insurance Code, make such premium and premium rate thereafter commensurate with the premium and premium rate for the benefits theretofore provided by the policy.
Form B. Insurance With Other Insurers, Expense Incurred Basis.
If there be other valid coverage, not with this insurer, on any individual with respect to whom coverage is provided by this policy, providing benefits for the same loss on a provision of service basis or an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of the loss, then the only liability under an expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total like amount under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of each portion of the premium paid as shall exceed the prorated portion of the amount of benefits so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the "like amount" of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage.
Instructions for Use of Form B
Instructions Applicable to Form A and Form B
Except as may be herein otherwise provided, the proration of benefits of a group disability policy because of other insurance covering the same loss is not appropriate to or applicable for use in group disability policies providing benefits other than benefits upon an expense incurred basis, except to the extent that Form A above is used in accordance with the instructions for its use, and no other such provision may be used. (Ins. C. 10369.5 and 10369.6.)
