375.995. Sex or marital status discrimination as to benefits or coverage prohibited.

554 words·~3 min read·/mo/chapter-375/375-995

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375.995. Sex or marital status discrimination as to benefits or coverage prohibited. — 1. As used in this section, the following terms shall mean:

(1)"Contract" , any insurance policy, plan, or binder, including any rider or endorsement thereto, offered by an insurer;

(2)"Insurer" , any insurance company, association, reciprocal or interinsurance exchange, not-for-profit hospital plan, not-for-profit professional health service plan, health maintenance organization, fraternal benefit society, beneficial association, or health services corporation, as defined in section 354.010 .

2. The purpose of this section is to eliminate the act of denying insurance benefits or coverage on the sole basis of sex or marital status in any terms or conditions of insurance contracts and in the underwriting criteria of insurance carriers.

3. This section shall apply to all contracts delivered or issued for delivery in this state by an insurer on or after October 1, 1986, and to all existing group contracts which are amended on or after October 1, 1986.

4. The availability of any insurance contract shall not be denied to any insured or prospective insured on the sole basis of the sex or marital status of such insured or prospective insured. Neither the amount of benefits payable under a contract, nor any term, condition, or type of coverage within a contract, shall be restricted, modified, excluded, or reduced solely on the basis of the sex or marital status of the insured or prospective insured except to the extent such restriction, modification, exclusion, or reduction is a result of the application of rate differentials permitted under the insurance laws of this state.

Nothing in this section shall prohibit an insurer from taking the marital status of an insured or prospective insured into account for the purpose of defining persons eligible for dependents' benefits. Specific examples of practices prohibited by this section include, but are not limited to, the following:

(1)Denying coverage to females gainfully employed at home, employed part time or employed by relatives when such coverage is offered to males similarly employed;

(2)Denying policy riders to females when such riders are available to males;

(3)Denying maternity benefits to insureds or prospective insureds purchasing an individual contract when comparable family coverage contracts offer maternity benefits;

(4)Denying, under group contracts, dependent coverage to husbands of female employees, when dependent coverage is available to wives of male employees;

(5)Denying disability income contracts to employed women when such coverage is offered to men similarly employed;

(6)Treating complications of pregnancy differently from any other illness or sickness under the contract;

(7)Restricting, reducing, modifying, or excluding benefits relating to coverage involving the genital organs of only one sex;

(8)Offering lower maximum monthly benefits to women than to men who are in the same classification under a disability income contract;

(9)Offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same classifications under a disability income contract;

(10)Establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract;

(11)Limiting the amount of coverage an insured or prospective insured may purchase based upon the insured's or prospective insured's marital status unless such limitation is for the purpose of defining persons eligible for dependents' benefits.

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(L. 1985 H.B. 527 § 1)

Effective 10-01-86