NAC690A.135. Credit accident and health insurance: Applicability of prima facie rates.  


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  • The rates set forth in subsections 2 and 3 of NAC 690A.125 apply to a policy of credit accident and health insurance that is offered to a debtor if the policy includes:

         1. Coverage for disability caused by any means, except that coverage may be excluded for disabilities resulting from:

         (a) Normal pregnancy;

         (b) War or any act of war;

         (c) Elective surgery;

         (d) Intentionally self-inflicted injury;

         (e) Sickness or injury caused by or resulting from the use of alcoholic beverages or controlled substances unless they are administered on the advice of, and taken as directed by, a licensed physician other than the insured;

         (f) Flight in any aircraft other than a commercially scheduled aircraft; or

         (g) A preexisting condition.

         2. For the exclusion set forth in paragraph (g) of subsection 1, the effective date of coverage for each part of the insurance attributable to a different advance or a charge to the plan account is the date on which the advance or charge occurs.

         3. A definition of disability providing that:

         (a) For the first 12 months of disability, total disability means the inability to perform the essential functions of the insured’s occupation.

         (b) After the first 12 months of disability, total disability means the inability of the insured to perform the essential functions of any occupation for which he or she is reasonably suited because of education, training or experience.

         4. A provision that is not more restrictive than a provision that requires the debtor to be employed full-time on the effective date of coverage and for at least 12 consecutive months before the effective date of coverage.

         5. A provision that prohibits coverage from becoming effective for a debtor after the debtor attains:

         (a) The age of 66 years and requires that all insurance for the debtor will terminate when the debtor attains the age of 70 years; or

         (b) The age of 68 years and requires that all insurance will terminate when the debtor attains the age of 72 years. If such a provision is included, prima facie rates for credit accident and health insurance may be increased by 1.8 percent and shall be deemed reasonable in relation to the benefits provided and may be used without filing additional actuarial information with the Commissioner.

         6. A daily benefit of not less than one-thirtieth of the monthly benefit payable under the policy.

     (Added to NAC by Comm’r of Insurance by R014-06, 3-23-2007, eff. 4-1-2007)