760 IAC 1-18-2 Interpretation principles; group and individual insurance

Sec. 2. Specific Principles of Interpretation. The Rules [ 760 IAC 1-18] apply to group as well as individual accident and sickness insurance. Because the two differ widely in many respects, it follows that one interpretation will not always suffice for both. When that is the case, a specific interpretation for group is set forth. Some of the distinctions between individual and group that should be taken into account in applying the Rules [ 760 IAC 1-18] are: (1) Frequently the prospective group policyholder is thoroughly conversant with insurance or employs competent insurance advisors. (2) Group plans are often the result of collective bargaining whereunder the plan must continue in existence for a specified period of time even though the insurance carrier may be changed. (3) Many group contracts are tailor-made to fit the policyholder's particular situation and are the result of extensive negotiations. (4) Group insurance generally contemplates that all or part of the premium is to be paid by the group policyholder. (5) The insurance provided by a group plan may be underwritten by several different insurers. (6) Much group insurance material is prepared and published after the contract is written. (7) Some states have statutory forms of group coverage. NOTE: Notwithstanding the principles set out above, the interpretations which follow are intended for purposes of guidance only, and are not considered by the Indiana Department of Insurance as being all-inclusive. Where appropriate, a particular set of facts will be governed by recourse to the interpretations of the rules included herein; however, the rules may be interpreted other than as expressed herein in any case where the Department, in its discretion, feels that such treatment is warranted.