Sec. 9. (a) A certificate that is issued under a group insurance policy to an individual participating group member must include the following information:

(1) The full name and address of the insurer.

Terms Used In Indiana Code 27-1-41-9

  • certificate: means a document issued to an individual group member as evidence of the group member's coverage under a master group insurance policy. See Indiana Code 27-1-41-1
  • group: means the following:

    Indiana Code 27-1-41-2

  • group administrator: means the officers or directors of a group or any other person legally vested with the responsibility to manage the affairs of a group. See Indiana Code 27-1-41-3
  • Insurance: means a contract of insurance or an agreement by which one (1) party, for a consideration, promises to pay money or its equivalent or to do an act valuable to the insured upon the destruction, loss or injury of something in which the other party has a pecuniary interest, or in consideration of a price paid, adequate to the risk, becomes security to the other against loss by certain specified risks; to grant indemnity or security against loss for a consideration. See Indiana Code 27-1-2-3
  • insurer: means a company, firm, partnership, association, order, society or system making any kind or kinds of insurance and shall include associations operating as Lloyds, reciprocal or inter-insurers, or individual underwriters. See Indiana Code 27-1-2-3
  • member: means one who holds a contract of insurance or is insured in an insurance company other than a stock corporation. See Indiana Code 27-1-2-3
  • premium: means money or any other thing of value paid or given in consideration to an insurer, insurance producer, or solicitor on account of or in connection with a contract of insurance and shall include as a part but not in limitation of the above, policy fees, admission fees, membership fees and regular or special assessments and payments made on account of annuities. See Indiana Code 27-1-2-3
(2) The policy number of the master policy.

(3) The full name, address, and telephone number of the group administrator that holds the master policy.

(4) A description of the coverage provided under the certificate, including the amount and term of the coverage.

(5) The amount of premium charged to the individual participating group member for the coverage.

(6) Coverage limits that specifically apply under the individual participating group member’s certificate.

(7) Unless:

(A) the master policy is incorporated by reference in the certificate; and

(B) a copy of the master policy accompanies the certificate;

all material terms and conditions of coverage under the certificate.

     (b) An insurer shall provide to each individual participating group member separate notice that provides instructions on claim submission procedures.

     (c) An insurer or group administrator shall deliver to each individual participating group member a certificate, an amended certificate, or an endorsement to a certificate if any of the following occurs:

(1) A change in coverage limits.

(2) A change in the type of coverage provided.

(3) An addition to, reduction in, or elimination of coverage provided.

(4) An addition of an exclusion of coverage.

As added by P.L.32-2012, SEC.2.