Current through Register Vol. 54, No. 45, November 9, 2024
Section 145.4 - Availability requirements(a) Availability of an insurance contract may not be denied to an insured or prospective insured on the basis of the sex or marital status of the insured or prospective insured. The amount of benefits payable or a term, condition or type of coverage may not be restricted, modified, excluded or reduced solely on the basis of sex or marital status of the insured or prospective insured. The preceding sentence may not be construed to preclude a person from requesting restrictions, modifications, exclusions or reductions of the benefits payable or of a term, condition or type of coverage of his individual policy. The requirements that the amount of benefits may not be restricted, modified, excluded or reduced solely on the basis of sex or marital status does not apply in the following instances:(1) The calculation of the amount of the insurance that can be purchased for a given amount of premium.(2) The calculation of settlement options or nonforfeiture benefits under a life insurance policy.(b) Examples of the practices prohibited by this chapter include but are not limited to the following: (1) Denying coverage to members of one sex gainfully employed at home, employed part-time or employed by relatives, when coverage is offered to members of the other sex similarly employed.(2) Denying policy riders to members of one sex when the riders are available to members of the other sex.(3) Denying, under group contracts, dependent coverage to husbands of female employes when dependent coverage is available to wives of male employes.(4) Denying disability income contracts to employed members of one sex when coverage is offered to members of the other sex similarly employed.(5) Treating complications of pregnancy different from another illness or sickness under the contract.(6) Restricting, reducing, modifying or excluding benefits relating to coverage involving the genital organs of only one sex when the restrictions, reductions, modifications or exclusions of benefits are not required for both sexes.(7) Offering lower maximum monthly benefits to members of one sex than to members of the other sex who are in the same classification under a disability income contract.(8) Offering more restrictive benefit periods and more restrictive definitions of disability to members of one sex than to members of the other sex in the same classification under a disability income contract.(9) Establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract.(10) Denying maternity benefits to insureds or prospective insureds purchasing an individual contract when comparable family coverage contracts offer maternity benefits.(11) Limiting the amount of coverage an insured or prospective insured may purchase based upon the marital status of the insured or prospective insured, unless the limitation is for the purpose of designating persons eligible for dependent benefits.(c) In individual policies containing a conversion privilege, no person may lose coverage due to a change in marital status. The person shall be issued a policy with the insurer which most nearly approximates the coverage of the policy which was in effect prior to the change in marital status. The insured may elect, in writing, to have a reduction in benefits in individual policies, if the benefits are available. The new policy shall be issued without evidence of insurability and shall become effective on the date that coverage terminated under the prior policy.