Cal. Code Regs. tit. 10 § 2245.2

Current through Register 2024 Notice Reg. No. 52, December 27, 2024

Section 2245.2 - Reduction or Proration of Benefits on Account of Simultaneous Coverage

At the option of the insurer, any U. C. D. policy may contain a provision relative to the reduction or proration of benefits on account of simultaneous coverage under the C. U. I. Code, but any provision shall be in one of the forms set forth in (a), (b), and (c) hereof only, or in the substance thereof. Connective words or phrases may be added, and there may be substituted for such words as "per day," "amount payable," and the like, other words or phrases more consistent with the other terminology used in the policy, but no such additions or substitutions shall be such as to change the substantive effect of the specified provisions.

Form (a) shall be used if the additional benefit while confined to a hospital as provided in the U. C. D. policy is the amount per day provided in the C. U. I. Code for additional benefits during hospital confinement. Form (b) shall be used if the additional benefits while confined to a hospital as provided in the U. C. D. policy is more than such amount per day. There shall be inserted in the blank space in form (a) and in the second blank space in form (b) the amount of the additional benefit during hospital confinement provided at the time of the issuance of the policy by the C. U. I. Code, and in the first blank space in form (b) there shall be inserted the amount by which the additional benefit per day while confined to a hospital exceeds the amount of the additional benefit during hospital confinement as provided in the C. U. I. Code. Form (c) shall be used if the insurer desires, on account of simultaneous coverage, to reduce or prorate basic U. C. D. benefits for loss of time as well as the additional benefits while confined to a hospital. Any of such forms (a), (b) or (c) may, by the terms of the U. C. D. policy, be made applicable to all employees, or to specified classes of employees determined by conditions pertaining to their employment, or to certain specific causes of disability objectively described, or to both such specified classes of employees and such specified causes of disability. From form (c) there may be omitted paragraph (1) in those cases in which the provision is made applicable only to a specified class or classes of employees which by the terms of the policy are entitled to the same benefits to which they would be entitled under the C. U. I. Code were they not covered by any voluntary plan.

Forms:

(a) In case of any day of hospital confinement for which an employee entitled to benefits hereunder is simultaneously covered by one or more other plans (including voluntary plans and the State Unemployment Compensation Disability Fund) and is accordingly entitled to other "additional benefits during hospital confinement" on account of the same disability, then the $__________per day otherwise payable hereunder shall be divided by the number of plans (including voluntary plans and the State Unemployment Compensation Disability Fund) under which he is simultaneously entitled to "additional benefits during hospital confinement" and the quotient shall be the amount payable hereunder for such day of confinement.

(b) In case of any days of hospital confinement for which an employee entitled to benefits hereunder is simultaneously covered by one or more other plans (including voluntary plans and the State Unemployment Compensation Disability Fund) and is accordingly entitled to other "additional benefits payable during hospital confinement" on account of the same disability, the amount of the "additional benefits payable during hospital confinement" payable hereunder for such day of hospital confinement shall be $__________ plus the quotient of $__________divided by the number of plans (including voluntary plans and the State Unemployment Compensation Disability Fund) under which he is simultaneously entitled to "additional benefits on account of hospital confinement."

(c) In case of any period for which an employee entitled to benefits hereunder is simultaneously covered by one or more other plans (including voluntary plans and the State Unemployment Compensation Disability Fund) and entitled to other Unemployment Compensation Disability benefits on account of the same disability, the amount payable for such period shall be:

(1) The amount, if any, by which the benefits to which the employee otherwise would have been entitled under this policy exceed the benefits to which he would have been entitled under the C. U. I. Code if he were not covered by any voluntary plan, plus

(2) The quotient of the amount of benefits to which the employee would have been entitled under the C. U. I. Code if he were not covered by any voluntary plan divided by the number of plans (including voluntary plans and the State Unemployment Compensation Disability Fund) under which he is simultaneously entitled to benefits.

Cal. Code Regs. Tit. 10, § 2245.2

1. New Sections 2245.2, 2245.3, and 2245.4 filed 5-27-50; effective 30th day thereafter (Register 20, No. 5).
2. Amendment to Sections 2245.2, 2245.3 and 2245.4 filed 4-4-56; effective thirtieth day thereafter (Register 56, No. 6).