Current through Register Vol. 48, No. 12, March 22, 2024
No company shall refuse to issue any contract of insurance,
certificate of insurance, notices of proposed insurance, policies, endorsements
or riders or decline to renew a contract, certificate, notice, policy,
endorsement or rider because of the sex, sexual orientation or marital status
of the insured or prospective insured. The amount of benefits payable or any
term, condition or type of coverage shall not be restricted, modified, excluded
or reduced on the basis of the sex, sexual orientation or marital status of the
insured or prospective insured. All underwriting criteria shall be applied in
all instances of similar circumstances without regard to the sex, sexual
orientation or marital status of the insured or prospective insured. When
benefits for elective procedures are offered, they must be offered
equally.
a) Examples of the practices
prohibited by this Section include, but are not limited to:
1) Offering coverage to males gainfully
employed at home, employed part-time or employed by relatives, while denying or
offering reduced coverage to females similarly employed;
2) Denying policy riders because of an
individual's sex, sexual orientation or marital status;
3) Denying, cancelling or refusing to renew
coverage, or providing coverage on different terms, because the insured or
prospective insured is residing with another person or persons of either sex
not related by blood or marriage;
4) Reducing disability benefits for women who
become disabled while not gainfully employed full-time outside the home when a
similar reduction is not applied to men;
5) Restricting availability of maternity
coverages or benefits based upon marital status;
6) Offering dependent coverage to wives of
male employees while denying dependent coverage to husbands of female
employees;
7) Establishment of
different conditions or benefit options based on an individual's sex, sexual
orientation or marital status. This includes more restrictive benefit periods
and more restrictive definitions of disability to women than to men, except as
permitted by this Part;
8)
Requiring an applicant to submit to a medical examination because of the
applicant's sex, sexual orientation or marital status;
9) Denying to divorced or single persons
coverage available to married persons;
10) Denying disability income contracts of
insurance, certificates of insurance, notices, policies, riders or endorsements
to those in similar occupational classifications because of an individual's
sex, sexual orientation or marital status;
11) Considering that portion of treatment
attributed to complications of pregnancy in a manner different than any other
illness or sickness covered by the contract, certificate, notice, policy,
endorsement or rider;
12) Limiting
the amount of coverage an insured or prospective insured may purchase based
upon the sex, sexual orientation or marital status of the insured or
prospective insured;
13) Denying
maternity coverage to an individual who has not purchased dependent or family
coverage when maternity coverage is otherwise available.
b) Examples of practices not prohibited by
this Section include, but are not limited to:
1) Offering annuity benefit amounts that
differ (such as through the election of a settlement option in a life insurance
policy) based upon the individual's sex;
2) Taking marital status into account for the
purpose of determining a spouse eligible for dependent benefits under a group
or family policy; marital status of the named insured or certificate holder
shall not be taken into account for the purpose of determining eligibility for
dependent benefits with regard to natural or adopted children and to
obligations as required by the courts. When maternity benefits are provided,
those benefits shall be applied to natural or adopted children who are covered
as dependents.