Effective 28 Aug 1991

376.806. Refund of health insurance unearned premium on notice of death of insured — refunded to whom — definitions — exception — failure to notify within one year. — 1. As used in this section, the following terms mean:

(1) "Health insurance contract", any one of the following when providing coverage to a resident of this state:

(a) Individual insurance policies providing coverage on an expense incurred basis;

(b) Individual indemnity type contracts issued by a health services corporation;

(c) Any individual contract issued by a health maintenance organization;

(d) Any self-insured health benefit plan, except to the extent preempted by federal law;

(e) Group health insurance in which the insured pays the full premium directly to the insurer, health services corporation or health maintenance corporation;

(2) "Health insurer", any entity issuing a health insurance contract.

2. A health insurer shall refund promptly any premium which it did not earn, upon notification of the death of any person covered under the health insurer's health insurance contract. The health insurer shall earn only that part of the premiums paid on behalf of the decedent which the period of coverage during which the decedent was alive bears to the whole period for which premiums were paid.

3. The refund of premiums shall be made directly to:

(1) The decedent's spouse at the time of the decedent's death;

(2) The primary insured person under the health insurance contract, if the decedent was not married at the time of death and was covered under the health insurance contract as a dependent;

(3) The decedent's estate, if neither subdivision (1) nor (2) of this subsection is applicable.

4. This section does not apply if the notification of the death of an insured person is given to the health insurer more than one year after the death of the decedent.

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(L. 1991 H.B. 561 § 1)