Life and Disability InsuranceGroup Life Policies
Section § 10200
This law allows life insurers to offer different types of insurance like life, disability, term, and endowment insurance as part of a group plan. They can choose to include annuities and adjust the premium rates to be lower than usual. Insurance can also be issued under a franchise or on a wholesale basis, allowing insurers to adjust the rates either up or down from the standard rates.
Section § 10200.2
This section allows an insurance company and a group policyholder to agree on how much of the premium the insurer can keep or set aside for future needs. The agreement can be part of a group or franchise policy. It identifies who a 'contracting entity' might be, which includes employers, associations, unions, or any organization that isn't mainly for getting insurance but includes groups involved in the policy.
Section § 10200.5
This law defines "franchise" or "wholesale" life insurance as policies given to a group at special rates lower than usual individual rates. Such insurance is only allowed if the insured are members of a professional association, employees under the same company, or connected to a sale or debt agreement. "Employees" include the owners in a business. Existing plans before this law's effective date won't be directly affected but can't insure more than $25,000 per individual without certain conditions. Changes to existing plans can involve changing insurers, rates, or adding certain benefits without affecting the plan's current coverage.
A "professional association" involves only licensed professionals like doctors, lawyers, or accountants.
Section § 10201
This law states that the specific types of group life insurance allowed are detailed in this chapter of the insurance code. No other forms are permitted.
Section § 10202
This California law outlines the conditions for a valid group life insurance policy. To qualify, the policy must cover at least two employees, whether from a public or private employer. The policy can be funded by the employer, the employee, or both and must cover all employees or specific groups based on employment conditions.
The policy must determine insurance amounts without allowing individual choice, and it cannot benefit the employer directly. Instead, it may benefit a trustee managing employee benefits like pensions or healthcare. Participation requires employee consent, and eligible employees must all have access to the offered benefits.
The policy should terminate if coverage drops below two employees, or if employee contributions exceed set limits when the premiums are based on a renewable term. Furthermore, the same application period and notification requirements apply to both former and retired employees as specified in another section of the law. Medical exams for the policy may be optional.
Section § 10202.5
This law clarifies who can be considered an "employee" eligible for inclusion under a group insurance policy. It specifies that the term can extend to officers, managers, and employees of related companies or firms, as well as certain individual business owners if their business is controlled by or controls the policyholder through ownership or contracts. Additionally, former employees, including retirees, and certain engaged business owners may also be covered, but coverage is limited to those actively engaged in the business. Importantly, this law ensures that only specific roles such as officers, managers, or compensated employees, and certain classes of former employees, can be covered under a group policy.
Section § 10202.8
This section outlines the conditions for issuing a group life insurance policy to trustees of a fund created by employers or trade associations for employees' benefit. It specifies eligibility criteria, including employees, union members, and certain former employees, but excludes directors who only perform typical director duties.
The funding of premiums can come from either employers/unions, the insured individuals, or a combination. A minimum of 50 people must be covered from the start, and the insurance amount is determined by a non-discriminatory plan rather than personal choice. The law allows policies to be issued without the need for a medical exam and clarifies that industries include licensed professions like medicine, law, and accountancy.
Section § 10202.81
This law allows the state, local governments, and cities to offer a specific type of insurance mentioned in Section 10202.8. They can contribute to this insurance fund just like private companies can.
Section § 10202.82
This law clarifies that the term “employees” includes individual owners and partners in a business that is a sole proprietorship or partnership. It also states that the term “employer” covers self-employed members of a labor union, regardless of whether they have employees.
Section § 10202.85
This law allows a county-issued insurance policy to cover employees from a district that is either entirely or partially within that county. However, this inclusion must comply with another law, specifically Section 53200.4 of the Government Code.
Section § 10203
This section discusses the rules for certain types of group life insurance policies. These policies must cover at least 25 members from organizations like unions, the National Guard, credit unions, or employee associations. Any premiums can be paid by the group, its members, or both. The policy is required to insure only the members of the group, not choosing individuals selectively, and should benefit people other than the sponsoring organization. For the policy to be valid, at least 75% of eligible members must be covered, and an employer must give written consent for premium deductions from employees’ salaries if applicable. Finally, if the group policy is for private employees, an employer's written consent is needed for deducting premiums from wages.
Section § 10203.1
This law outlines the conditions for a specific type of group life insurance available to employees of the California State University system.
First, it must cover at least 25 employees and be issued under a policy approved by the university trustees. The insurance premiums can be paid wholly by the employees, or partly by the State of California, with any balance covered by the employees. Third-party payments on behalf of employees count as employee payment.
The policy should only insure employees, without allowing for individual selection, and should not benefit the trustees. At least 75% of eligible employees, or any defined employment class, must be covered. If the initial group meets this threshold, other classes can be included as demand arises. Employees may need to provide proof of insurability if they initially opt-out and wish to enroll later.
Section § 10203.2
This California law outlines a type of group life insurance for state employees that must cover at least 25 people initially. The policy can be funded by employees, the state, or both, and it is specifically for managers, confidential employees, and those not defined as 'state employees' under another law. The insurance covers a broad group without allowing individual selection, and the insurance benefits cannot go to the Department of Human Resources. It requires at least 75% of eligible employees to be covered, or as many from a particular class or position, with the option to insure more after the initial offering, subject to proof of eligibility if they didn't sign up when first eligible.
Section § 10203.4
This California insurance law allows employees with group life insurance policies to extend their coverage to dependents, such as spouses and children, without the option for individual selection. The coverage for dependents cannot exceed the amount of insurance on the employee's life.
The term 'dependent' includes a spouse, a minor child, and children up to 26 years old. It also covers children who cannot support themselves due to disabilities if the employee provides proof of this dependency and incapacity within 31 days after the child reaches the coverage limit age.
Lastly, the cost of dependent coverage can be covered by the employer, employee, or both together.
Section § 10203.5
This California law explains a specific type of group life insurance for borrowers or purchasers who owe money to a financial institution or vendor. To qualify, the group must have at least 100 new members each year, or 50 for credit unions. The coverage amount must not exceed the loan or debt balance. Repayments should be made in equal installments over a period not longer than 40 years, but exceptions apply for certain loans. The insurance policy benefits the financial institution or vendor, and they pay the premiums. This type of policy isn't subject to some general insurance regulations.
Section § 10203.7
This California law describes a type of group life insurance policy that can be issued for insurance agents. To qualify: it must cover at least 10 agents when first issued; the policy can be obtained by a principal or insurance company who pays the premium; it insures agents based on their service agreement; insurance amounts are determined by a plan that avoids personal selection; benefits must be for persons other than the principal; and it requires joint payment of the premium by the principal and agents, covering at least 75% of eligible agents. Coverage ends if the number of insured agents drops below 10 or 75% of eligible agents, or if agent contributions exceed a specified limit without any hazardous duty surcharge. Medical exams may or may not be necessary for obtaining coverage.
Section § 10203.8
This law explains the conditions under which life insurance can be considered a type of group life insurance, specifically for depositors in a savings account plan with a financial institution. It covers life insurance for account holders who make regular deposits over a period not exceeding 60 months. The insurance amount is limited to the difference between the total deposits and the maximum plan deposit, capped at $1,500 per person. The policy must involve at least 100 new participants each year with the financial institution as the beneficiary, and premiums paid through the institution. Importantly, this type of insurance is exempt from certain legal provisions in other sections.
Section § 10203.9
This law allows a new group life insurance policy to replace an existing one if it meets three conditions: the new policy offers the same or better benefits at the same or lower cost, it covers all individuals from the old policy, and at least 90% of those individuals agree to switch to the new policy.
Section § 10203.10
This law explains a specific form of life insurance called group investment return assurance. It's a type of insurance policy tied to investments in redeemable securities, ensuring compensation if those investments lose value under certain conditions. It applies to groups of at least 100 investors, and insurance is capped at the amount of the investment or $20,000, whichever is lower.
The insurance policy is usually applied for by investment companies, with premiums potentially paid by either the company or the investor. To offer this insurance, companies must prove their stability and meet financial requirements, including maintaining a reserve fund. Only approved insurers can issue this type of policy in California, and forms must be filed with and approved by the insurance commissioner.
Section § 10203.55
This law defines what is considered an agricultural or horticultural loan commitment. It's a binding agreement to lend money up to a certain amount for agricultural or horticultural needs.
Such a commitment must be issued by a legitimate lender like a national or state commercial bank or a federal intermediate credit bank or production credit association under the Farm Credit Act of 1933. These institutions must be legally permitted to operate in California.
Section § 10204
This section of the law explains who is considered an 'employer' and an 'employee' within certain contexts. An 'employer' can be a union, association, institution, vendor, credit union, creditor, principal, or trustees as specified in other sections. Meanwhile, an 'employee' includes union members, credit union members, debtors, purchasers, and certain agents and employees mentioned in related sections.
Section § 10204.5
This law allows the commissioner to approve group life insurance policies in addition to those normally issued if certain criteria are met. These criteria include having at least 10 members in the group, a shared interest among them, reasonable premiums, and that the group wasn't formed just to get insurance. Policies must be economically beneficial and not harmful to the public. Also, associations must have bylaws and exist for over two years. Insurers should have experience with other types of group insurance and not be primarily focused on the type in question.
Insurers can refuse coverage to individuals who don't meet their insurability standards. Additionally, a $500 fee applies to each application or filing.
Section § 10205
In California, a group life insurance policy cannot be issued or delivered unless first approved by the insurance commissioner, who must be provided with a copy of the policy form. There are exceptions in another section (10205.5), and the policy must include specific provisions detailed in Sections 10206 to 10210, unless Section 10211 applies.
Section § 10205.5
Insurance companies in California can provide group life insurance coverage before getting formal approval of the policy form, as long as certain conditions are met. First, the group must be eligible, and a memorandum detailing the coverage must be given to the future policyholder, which will end if the official policy isn't approved and issued within 90 days.
If the coverage begins, the insurer has 60 days to submit the policy form for approval and make any necessary adjustments. If approval isn't granted, the coverage must end as initially stated. If more time is needed, the insurer can request an extra 30 days, potentially prolonging the insurance period upon agreement with the policyholder. Policies are automatically approved unless rejected within 30 days of submission.
Section § 10205.6
This section allows the commissioner to suspend or revoke an insurance company's permission if they mess up in certain ways. This includes misrepresenting the conditional nature of coverage, failing to cancel or end coverage on time, or issuing memorandums not up to standard. Other reasons include being slow to make necessary policy revisions, consistently failing to meet insurance code requirements, or not informing insured individuals about the conditional nature of their coverage. Finally, if the insurer's actions are careless or negligent enough to mislead policyholders or put them at risk of loss, the commissioner can step in.
Section § 10206
This law states that once a life insurance policy has been active for two years, it generally can't be challenged for anything except unpaid premiums. However, if someone uses a fake identity during the application process, any resulting insurance contract is not valid at all. Insurers won't form a real contract with you if an impostor takes your place during application steps, like medical exams or giving samples, and pretends to be you.
Section § 10206.5
This rule allows insurance companies to limit their responsibility, or lower the payout, for claims related to war, military service, or aviation activities. The insurance commissioner can set rules for when these limits are used in current or future policies, after giving notice and holding a hearing.
Section § 10207
This law requires insurance policies to have a provision stating that the policy, along with any applications from the employer and employees, make up the full insurance contract.
It also clarifies that any statements made by the employer or employees are considered representations (not guarantees) unless there is fraud, and such statements cannot be used to contest a claim unless they are written in an application.
Section § 10208
If an employee's age is incorrectly stated on an insurance policy, this law requires that the policy includes a way to fairly adjust either the premium cost or the payout amount.
Section § 10209
This law requires that insurance policies include certain provisions for employees. When an employee is insured under a group life insurance policy, the employer must provide a certificate detailing the insurance coverage, who it pays, and other rights. If an employee's job ends, they have 31 days to apply for an individual life insurance policy without showing they are insurable. The new policy will cover the same amount as their group policy did.
If an employee dies within those 31 days but before the policy starts, their life insurance claim is still valid under the group policy. Employees must be notified of their right to individual coverage at least 15 days before the deadline. If not, they get an extra chance to apply for up to 60 days after their original window closes. Some of these rules also apply to an employee's spouse's life insurance.
Section § 10209.1
This law states that if you receive an individual insurance certificate under a group policy, it should have your name or some way to identify it as yours unless you’re not required to pay anything regularly for the insurance. In that case, the certificate doesn’t need to be personalized as long as it clearly describes who is eligible and when you’re covered under the policy.
Section § 10209.3
This law allows people with group life insurance policies to assign their ownership rights, like naming a beneficiary, to someone else who isn't the policyholder. Even if someone has a terminal illness, they can sell their insurance policy for cash. However, this doesn't apply if the policy is being used as a loan guarantee. If a terminally ill person sells their policy, the viatical broker (the person handling the sale) must inform their spouse.
Section § 10210
This law requires that an insurance policy for a group of employees must include all new employees eligible for that insurance. However, if both the employer and employees share the insurance cost, an employee who does not sign up for the insurance during the initial eligible period must prove they are in good health before being covered.
Section § 10210.5
This law explains who is responsible for the payment of insurance premiums. It clarifies that the responsibility involves paying, but not necessarily transmitting or collecting the premiums. Normally, the policyholder handles transmission and collection unless the policy specifies otherwise. There are special cases where insurers can collect directly: when covering employees from multiple employers, individual collections from employers or employees is permitted, especially if the policy includes over 100 employers or employees. For government employees, the insurer can collect from workers if their unit won't handle deductions. If a policyholder is temporarily absent from work for no more than 90 days, they can pay directly without extra charges.
Section § 10211
This section allows group life insurance policies to include certain provisions based on their location. If issued by an out-of-state insurer in California, the policy can have provisions required by that insurer's home state laws. If a California insurer issues a policy outside of California, it can include provisions required by the laws of the location where it is issued.
Additionally, these policies can include provisions from sections 10205 to 10210 if the insurance commissioner believes they are more beneficial for the employer or the employee than the standard requirements.
Section § 10212
This section means that in group insurance policies provided by a domestic life insurer, the employer is considered the main policyholder. If there are any votes at insurer meetings, the employer gets one vote.
Section § 10214
If an insurance company pays a dividend or refunds a premium on a group life insurance policy, any leftover amount after covering insurance costs must benefit the insured employees or members and their families. The policyholder can choose to apply this rule to all their group life and disability insurance policies.