58-16-16. Industry fund groups--Minimum number of persons required to be insured.

A policy issued under § 58-16-12 must cover at date of issue at least one hundred persons; and it must cover an average of not less than three persons per employer unit unless the policy is issued to the trustees of a fund established by employers which have assumed obligations through a collective bargaining agreement and are participating in the fund either pursuant to those obligations with regard to one or more classes of their employees which are encompassed in the collective bargaining agreement or as a method of providing insurance benefits for other classes of their employees, or unless the policy is issued to the trustees of a fund established by one or more labor unions.

Source: SL 1966, ch 111, ch 24, § 1 (4) (d).

58-16-17. Industry fund groups--Payment of premium.

The premium for a policy issued under § 58-16-12 shall be paid by the trustees wholly from funds contributed by the employer or employers of the insured persons, or by the union or unions, or by both, or partly from such funds and partly from funds contributed by the insured persons. A policy on which part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance may be placed in force only if at least seventy-five percent of the then eligible persons, excluding any as to whom evidence of insurability is not satisfactory to the insurer, elect to make the required contributions. A policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance must insure all eligible persons, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer.

Source: SL 1966, ch 111, ch 24, § 1 (4) (c).

58-16-18. Insurance of employees or members of group against death of dependents.

Any group life policy issued under §§ 58-16-2 to 58-16-17, inclusive, may be extended to insure the employees or members against loss due to the death of their spouses and minor children, or any class or classes thereof, subject to the requirements of §§ 58-16-19 to 58-16-22, inclusive.

Source: SL 1966, ch 111, ch 24, § 2.

58-16-19. Payment of premium on extended group coverage.

The premium for insurance under § 58-16-18 shall be paid by the policyholder, either from the employer's or union's funds or funds contributed by the employer or union, or from funds contributed by the insured employees or members, or from both. If any part of the premium is to be derived from funds, contributed by the insured employees or members, the insurance with respect to spouses and children may be placed in force only if at least seventy-five percent of the then eligible employees or members, excluding any as to whose family members evidence of insurability is not satisfactory to the insurer, elected to make the required contribution. If no part of the premium is to be derived from funds contributed by the employees or members, all eligible employees or members, excluding any as to whose family members evidence of insurability is not satisfactory to the insurer, must be insured with respect to their spouses and children.

Source: SL 1966, ch 111, ch 24, § 2 (1).

58-16-20. Amount of insurance on dependents based upon plan precluding individual selection.

The amount of insurance under § 58-16-18 is based upon some plan precluding individual selection either by the employees or members or by the policyholder, employee or union.

Source: SL 1966, ch 111, ch 24, § 2(2); SL 1983, ch 374, § 2.

58-16-21. Termination of group life policy extended to dependents--Issuance of individual policy to spouse, application and payment of premium.

Upon termination of insurance under § 58-16-18 with respect to the members of the family of any employee or member by reason of the employee's or member's termination of employment, termination of membership in the class or classes eligible for coverage under the policy, or death, the spouse shall be entitled to have issued by the insurer, without evidence of insurability, an individual policy of life insurance without health or other supplementary benefits, providing application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one days after such termination, subject to the requirements of subdivisions 58-16-39(1), (2), and (3). If any group policy terminates or is amended so as to terminate the insurance of any class of employees or members and the employee or member is entitled to have issued an individual policy under § 58-16-40, the spouse shall also be entitled to have issued by the insurer an individual policy, subject to the conditions and limitations provided above. If the spouse dies within the period during which he would have been entitled to have an individual policy issued in accordance with this provision, the amount of life insurance which he would have been entitled to have issued under such individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefor has been made.

Source: SL 1966, ch 111, ch 24, § 2 (3).

58-16-22. Group life policy extended to dependents--One certificate issued to insured person.

Notwithstanding § 58-16-38, only one certificate need be issued for delivery to an insured person if a statement concerning any dependent's coverage is included in such certificate.

Source: SL 1966, ch 111, ch 24, § 2 (4).

58-16-23. Issuance of group life policy to creditor--Purpose.

A policy of group life insurance may be issued to a creditor, who shall be deemed the policyholder, to insure debtors of the creditor, subject to the requirements of §§ 58-16-24 to 58-16-29, inclusive.

Source: SL 1966, ch 111, ch 24, § 1 (2).

58-16-24. Debtors eligible for insurance under group life policy--Policy may define "debtor".

The debtors eligible for insurance under a policy issued under § 58-16-23 shall be all of the debtors of the creditor whose indebtedness is repayable either in installments or in one sum at the end of a period not in excess of eighteen months from the initial date of debt, or all of any class or classes thereof determined by conditions pertaining to the indebtedness or to the purchase giving rise to the indebtedness. The policy may provide that the term "debtors" shall include the debtors of one or more subsidiary corporations, and the debtors of one or more affiliated corporations, proprietors, or partnerships if the business of the policyholder and of such affiliated corporations, proprietors, or partnerships is under common control through stock ownership, contract, or otherwise. No debtor shall be eligible unless the indebtedness constitutes an irrevocable obligation to repay which is binding upon him during his lifetime, at and from the date the insurance becomes effective upon his life.

Source: SL 1966, ch 111, ch 24, § 1 (2) (a).

58-16-25. Number of insureds required for group coverage of debtors--Evidence of insurability--Age exclusions.

A policy may be issued under § 58-16-23 only if the group of eligible debtors is then receiving new entrants at the rate of at least one hundred persons yearly, or may reasonably be expected to receive at least one hundred new entrants during the first policy year, and only if the policy reserves to the insurer the right to require evidence of individual insurability if less than seventy-five percent of the new entrants become insured. The policy may exclude from the classes eligible for insurance classes of debtors determined by age.

Source: SL 1966, ch 111, ch 24, § 1 (2) (c).

58-16-26. Payment of premium for group coverage of debtors.

The premium for a policy issued under § 58-16-23 shall be paid by the policyholder, either from the creditor's funds, or from charges collected from the insured debtors, or from both. A policy on which part or all of the premium is to be derived from the collection from the insured debtors of identifiable charges not required of uninsured debtors shall not include, in the class or classes of debtors eligible for insurance, debtors under obligations outstanding at its date of issue without evidence of individual insurability unless at least seventy-five percent of the then eligible debtors elect to pay the required charges. A policy on which no part of the premium is to be derived from the collection of such identifiable charges must insure all eligible debtors, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer.

Source: SL 1966, ch 111, ch 24, § 1 (2) (b).

58-16-27. Amount of insurance on life of debtor limited.

The amount of insurance under § 58-16-23 on the life of any debtor may at no time exceed the amount owed by him to the creditor.

Source: SL 1966, ch 111, ch 24, § 1 (2)(f); SL 1969, ch 138; SL 1987, ch 376.

58-16-28. Maximum amount repayable in installments to creditor--Duration of insurance--Limited to amount of unpaid indebtedness.

The amount of insurance under § 58-16-23 on the life of any debtor shall at no time exceed the amount owed by him which is repayable in installments to the creditor. Where the indebtedness is repayable in one sum to the creditor, the insurance on the life of any debtor shall in no instance be in effect for a period in excess of eighteen months except that such insurance may be continued for an additional period not exceeding six months in the case of default, extension or recasting of the loan. The amount of the insurance on the life of any debtor shall at no time exceed the amount of the unpaid indebtedness.

Source: SL 1966, ch 111, ch 24, § 1 (2) (d).

58-16-29. Payment to policyholder as reduction of indebtedness.

The insurance under § 58-16-23 shall be payable to the policyholder. Such payment shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of such payment.

Source: SL 1966, ch 111, ch 24, § 1 (2) (e).

58-16-30. Association groups--Insurance of members--Minimum number of members required.

A policy of group life insurance may be issued to an association, which has been in existence for one or more years, and which has a constitution and bylaws, and which was not formed for the exclusive purpose of procuring insurance, insuring at least one hundred members of the association for the benefit of persons other than the association or its officers.

Source: SL 1966, ch 111, ch 24, § 1 (5).

58-16-31. Standard provisions required for group life insurance policies, exceptions.

No policy of group life insurance shall be delivered in this state unless it contains in substance the provisions set forth in §§ 58-16-32 to 58-16-42, inclusive, or provisions which in the opinion of the director are more favorable to the persons insured, or at least as favorable to the persons insured and more favorable to the policyholder, provided, however, that §§ 58-16-38 to 58-16-42, inclusive, shall not apply to policies issued to a creditor to insure debtors of such creditor; that the standard provisions required for individual life insurance policies shall not apply to group life insurance policies; and that if the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision which in the opinion of the director is equitable to the insured persons and to the policyholder, but nothing herein shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies.

Source: SL 1966, ch 111, ch 24, § 3.

58-16-32. Copy of application attached to policy--Statements of insured not warranties--Statement by insured, use in contest.

A policy of group life insurance shall contain a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such person or to his beneficiary.

Source: SL 1966, ch 111, ch 24, § 3 (3).

58-16-33. Misstatement of age of insured--Equitable adjustments of premiums or benefits.

A policy of group life insurance shall contain a provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, such provision to contain a clear statement of the method of adjustment to be used.

Source: SL 1966, ch 111, ch 24, § 3 (5).

58-16-34. Evidence of individual insurability--Right of insurer to require.

A policy of group life insurance shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of his coverage.

Source: SL 1966, ch 111, ch 24, § 3 (4).

58-16-35. Incontestability provision required--Exceptions.

A policy of group life insurance shall contain a provision that the validity of the policy may not be contested, except for nonpayment of premiums, after it has been in force for two years from its date of issue; and that no statement made by any person insured under the policy relating to the person's insurability may be used in contesting the validity of the insurance with respect to which such statement was made, after such insurance has been in force prior to the contest for a period of two years during such person's lifetime. No statement made by the group policyholder or any person insured under the group policy may be contested unless it is contained in a written instrument signed by that person. The two-year limitation for contesting the validity of the insurance for any person insured under the policy does not apply to fraud on the part of the applicant or insured.

Source: SL 1966, ch 111, ch 24, § 3 (2); SL 2010, ch 236, § 1.

58-16-36. Grace period required.

A policy of group life insurance shall contain a provision that the policyholder is entitled to a grace period of thirty-one days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period.

Source: SL 1966, ch 111, ch 24, § 3 (1).

58-16-37. Required statement of benefits furnished to insured debtors.

A policy of group life insurance issued to a creditor to insure debtors of such creditor shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form which will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid thereunder by reason of his death shall be applied to reduce or extinguish the indebtedness.

Source: SL 1966, ch 111, ch 24, § 3 (11).

58-16-38. Certificate to be delivered to insured.

Except as provided in § 58-16-31, a policy of group life insurance shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which he is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in §§ 58-16-39 to 58-16-41, inclusive.

Source: SL 1966, ch 111, ch 24, § 3 (7).

58-16-38.1. Assignment of policy not prohibited--Rights vested in assignee.

Nothing in this chapter or in any other law shall be construed to prohibit a person whose life is insured under any policy of group life insurance from making an assignment of all or any part of his rights and privileges under such policy including specifically, but not by way of limitation, any right to designate a beneficiary thereunder and any right to have an individual policy issued to him in accordance with §§ 58-16-39 and 58-16-40. Subject to the terms of any contract between the parties, such an assignment by an insured, made either before or after the effective date of this section, is valid for the purpose of vesting in the assignee, in accordance with any provisions included therein as to the time at which it is to be effective, all of such rights and privileges so assigned, but without prejudice to the insurer on account of any payment it may make or individual policy it may issue in accordance with §§ 58-16-39 and 58-16-40 prior to receipt of notice of this assignment.

Source: SL 1971, ch 272.

58-16-39. Termination of employment or membership causing policy to cease--Issuance of individual policy to person entitled thereto, application and payment of premium.

Except as provided in § 58-16-31, a policy of group life insurance shall contain a provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person shall be entitled to have issued to him by the insurer, without evidence of insurability, an individual policy of life insurance without health or other supplementary benefits, provided application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one days after such termination, and provided further that:

(1)    The individual policy shall, at the option of such person, be on any one of the forms, except term insurance, then customarily issued by the insurer at the age and for the amount applied for;

(2)    The individual policy shall be in an amount not in excess of the amount of life insurance which ceases because of such termination, less the amount of any life insurance for which such person is or becomes eligible under the same or any other group policy within thirty-one days after such termination, provided that any amount of insurance which shall have matured on or before the date of such termination as an endowment payable to the person insured, whether in one sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount which is considered to cease because of such termination; and

(3)    The premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which such person then belongs, and to his age attained on the effective date of the individual policy.

Source: SL 1966, ch 111, ch 24, § 3 (8).

58-16-40. Termination of group policy--Issuance of individual policy to insured person, amount of policy.

Except as provided in § 58-16-31, a group life insurance policy shall contain a provision that if the group policy terminates or is amended to terminate the insurance of any class of insured persons, any person insured at the termination date whose insurance terminates and who has been so insured for at least five years prior to that termination date may have an individual life insurance policy issued to him by the insurer. That policy is subject to the conditions and limitations provided in § 58-16-39. However, the group policy may provide that the total amount of the individual policy may not exceed the difference between the amount of the person's group life insurance protection that ended because of the group policy termination or amendment and the amount of any life insurance for which he is eligible under any group policy issued or reinstated by any insurer within thirty-one days after that termination date.

Source: SL 1966, ch 111, ch 24, § 3 (9); SL 1983, ch 374, § 1.

58-16-41. Effect of death of person insured under group policy during period in which entitled to individual policy.

Except as provided in § 58-16-31, a policy of group life insurance shall contain a provision that if a person insured under the group policy dies during the period within which he would have been entitled to have an individual policy issued to him in accordance with § 58-16-39 or 58-16-40 and before such an individual policy shall have become effective, the amount of life insurance which he would have been entitled to have issued to him under such individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefor has been made.

Source: SL 1966, ch 111, ch 24, § 3 (10).

58-16-42. Payment of death benefit--Designated beneficiary--Person incurring expenses incident to last illness or death.

Except as provided in § 58-16-31, a policy of group life insurance shall contain a provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, subject to the provisions of the policy in the event there is no designated beneficiary, as to all or any part of such sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of such sum not exceeding five hundred dollars to any person appearing to the insurer to be equitably entitled thereto by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured.

Source: SL 1966, ch 111, ch 24, § 3 (6).

58-16-43. Chapter inapplicable to prior policies.

The provisions of this chapter shall not apply to any contracts or policies entered into or issued prior to February 8, 1966, nor to any extensions, renewals, or modifications thereof or amendments thereto whenever made.

Source: SL 1966, ch 111, ch 24, § 4.

58-16-44. Insurers to pay interest on life insurance proceeds.

Any insurer admitted to transact life insurance in this state shall pay interest on proceeds of, or payments under, any individual or group policy of life insurance which are payable to any beneficiary under a policy issued for delivery in this state.

Source: SL 1987, ch 375, § 1.

58-16-45. Computation of interest.

Interest payable pursuant to § 58-16-44 shall be computed from the date of death of the insured until the date of payment and shall be at the rate of four percent per annum or not less than the current rate of interest on death proceeds left on deposit with the insurer under an interest settlement option, whichever rate is greater.

Source: SL 1987, ch 375, § 2.

58-16-46. Interest not required where beneficiary elects to receive other than lump sum payment.

The provisions of § 58-16-44 do not require the payment of interest in any case in which the beneficiary elects in writing delivered to the insurer to receive the proceeds of or payments under a life insurance policy by any means other than a lump sum payment.

Source: SL 1987, ch 375, § 3.

58-16-47. Notice to beneficiary of interest.

In any case in which interest on the proceeds of, or payments under, any policy of life insurance becomes payable pursuant to § 58-16-44, the insurer shall notify the named beneficiary or beneficiaries at their last known address that interest will be paid on the proceeds of or payments under the policy. The notice shall specify the rate of interest to be paid.

Source: SL 1987, ch 375, § 4.

58-16-48. Application limited.

The provisions of §§ 58-16-44 to 58-16-48, inclusive, shall apply only to deaths of insureds which occur on or after July 1, 1987.

Source: SL 1987, ch 375, § 5.

58-16-49. Carrier and group-type basis defined.

Terms used in §§ 58-16-49 to 58-16-54, inclusive, mean:

(1)    "Carrier," a person or an entity that offers or provides a policy, contract, or certificate of group life insurance coverage in this state. Carrier includes an insurer, or any other person or entity providing a policy, contract, or certificate of group life insurance coverage subject to regulation under this title;

(2)    "Group-type basis," a benefit plan, other than a salary budget plan utilizing individual insurance policies or subscriber contracts, which meets the following conditions:

(a)    Coverage is provided through insurance policies to classes of employees or members defined in terms of conditions pertaining to employment or membership;

(b)    The coverage is not available to the general public and can be obtained and maintained only because of the covered person's membership in or connection with the particular organization or group;

(c)    There are arrangements for bulk payment of premiums or subscription charges to the carrier; and

(d)    There is sponsorship of the plan by the employer, union, or association.

Source: SL 2009, ch 261, § 1.

58-16-50. Application of §§ 58-16-49 to 58-16-54.

The provisions of §§ 58-16-49 to 58-16-54, inclusive, apply to any group life insurance policy issued or provided by a carrier on a group or group-type basis covering persons as employees of employers or as members of unions or associations.

Source: SL 2009, ch 261, § 2.

58-16-51. Discontinuance of group life insurance policies.

If a policy or contract subject to the provisions of §§ 58-16-49 to 58-16-54, inclusive, provides for automatic discontinuance of the policy or contract after a premium or subscription charge has remained unpaid through the grace period allowed for such payment, the carrier is liable for valid claims for covered losses incurred prior to the end of the grace period.

If the actions of the carrier after the end of the grace period indicate that the carrier considers the policy or contract as continuing in force beyond the end of the grace period, such as, by continuing to recognize claims subsequently incurred, the carrier is liable for valid claims for losses beginning prior to the effective date of the written notice of discontinuance to the policyholder or other entity responsible for making payments or submitting subscription charges to the carrier. The effective date of discontinuance may not be prior to midnight at the end of the third scheduled workday after the date upon which the notice is delivered.

Source: SL 2009, ch 261, § 3.

58-16-52. Notice of discontinuance.

A notice of discontinuance given by the carrier shall include a request to the group policyholder or other entity involved to notify employees covered under the policy of the date as of which the group policy, contract, or certificate will discontinue and to advise that, unless otherwise provided in the policy, contract, or certificate, the carrier is not liable for claims for losses incurred after the date of discontinuance. The notice of discontinuance also shall advise, in any instance in which the plan involves employee contributions, that if the policyholder or other entity continues to collect contributions for the coverage beyond the date of discontinuance, the policyholder or other entity may be held solely liable for the benefits with respect to which the contributions have been collected.

The carrier shall prepare and furnish to the policyholder or other entity at the same time the carrier gives a notice of discontinuance, a supply of, or access to, notice forms to be distributed to the employees or members concerned, indicating the discontinuance and the effective date of the discontinuance, and urging the employees or members to refer to their certificates or contracts in order to determine what rights, if any, are available to them upon the discontinuance.

Source: SL 2009, ch 261, § 4.

58-16-53. Extension of benefits at discontinuance in the event of total disability.

Each group policy, contract, or certificate subject to the provisions of §§ 58-16-49 to 58-16-54, inclusive, issued on or after July 1, 2009, or under which the level of benefits is altered, modified, or amended on or after July 1, 2009, shall provide a reasonable provision for extension of benefits in the event of total disability at the date of discontinuance of the group policy, contract, or certificate as required by this section.

In the case of a group life plan that contains a disability benefit extension of any type, including premium waiver extension, extended death benefit in event of total disability, or payment of income for a specified period during total disability, the discontinuance of the group policy, contract, or certificate may not operate to terminate the extension.

Any applicable extension of benefits or accrued liability shall be described in any policy or contract involved as well as in group insurance certificates. The benefits payable during any period of extension of benefits or accrued liability may be subject to the policy's, contract's, or certificate's regular benefit limits, such as benefits ceasing at exhaustion of a benefit period or of maximum benefits.

Source: SL 2009, ch 261, § 5.

58-16-54. Responsibilities of prior carrier and succeeding carrier upon discontinuance.

The following provisions dictate the responsibility of the prior carrier and succeeding carrier when coverage is discontinued:

(1)    After discontinuance of the policy, contract, or certificate, the prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The position of the prior carrier shall be the same whether the group policyholder or other entity secures replacement coverage from a new carrier, self-insures, or foregoes the provision of coverage;

(2)    If the individual was validly covered under the prior plan on the date of discontinuance, each individual who is eligible for coverage in accordance with the succeeding carrier's plan of benefits is, with respect to the class or classes of individuals, eligible and shall be covered under the succeeding carrier's plan if (a) any actively-at-work and nonconfinement rules are met, and (b) if required by the succeeding carrier, the individual requests enrollment;

(3)    Each individual not covered under the succeeding carrier's plan of benefits in accordance with subdivision (2) shall nevertheless be covered by the succeeding carrier in accordance with the following rules if the individual was validly covered, including benefit extension, under the prior plan on the date of discontinuance and if the individual is a member of the class or classes of individuals eligible for coverage under the succeeding carrier's plan. Any reference in the following subdivisions to an individual who was or was not totally disabled is a reference to the individual's status immediately prior to the date the succeeding carrier's coverage becomes effective;

(4)    The minimum level of benefits to be provided by the succeeding carrier shall be the applicable level of benefits of the prior carrier's plan reduced by any benefits payable by the prior plan;

(5)    Coverage shall be provided by the succeeding carrier until the earliest of the following dates:

(a)    The date the individual becomes eligible under the succeeding carrier's plan as described in subdivision (1);

(b)    The date the individual's coverage would terminate in accordance with the succeeding carrier's plan provisions applicable to individual termination of coverage, such as at termination of employment or ceasing to be an eligible dependent; or

(c)    In the case of an individual who was totally disabled, and in the case of a type of coverage for which § 58-16-53 requires an extension of benefits or accrued liability, the end of any period of extension benefits or accrued liability that is required of the prior carrier by § 58-16-53, or if the prior carrier's policy, contract, or certificate is not subject to that section, but would have been required of the prior carrier had the policy, contract, or certificate been subject to § 58-16-53 at the time the prior carrier's plan was discontinued and replaced by the succeeding carrier's plan;

(6)    In any situation in which a determination of the prior carrier's benefit is required by the succeeding carrier, at the succeeding carrier's request the prior carrier shall furnish a statement of the benefits available or pertinent information, sufficient to permit verification of the benefit determination or the determination itself by the succeeding carrier. For the purposes of this subdivision, benefits of the prior plan shall be determined in accordance with all of the definitions, conditions, and covered expense provisions of the prior plan rather than those of the succeeding plan. The benefit determination shall be made as if coverage had not been replaced by the succeeding carrier; and

(7)    A succeeding carrier's policy may contain a provision limiting benefits to employees who are actively at work. However, any individual who remains as an employee, was covered by the prior carrier, and was disabled as of the date the succeeding carrier coverage became effective for that employer, will continue to be covered by the prior carrier as long as the individual remains an employee. An individual who is not disabled and is not at work on the date the succeeding carrier's coverage commences is considered actively at work as long as the absence from work is an employer-approved absence.

Source: SL 2009, ch 261, § 6; SL 2021, ch 210, § 9.