1. a proper claim form; 2. written notice that the person is a possessory or managing conservator of the Dependent Child on whose behalf the claim is made; and 3. a certified copy of the court order designating the person as possessory or managing conservator of the Dependent Child or other evidence designated by rule of the State Department of Insurance that the person is eligible for the benefits.
8) Under the Administrative Provisions section, the following changes are made:
a) The Change in Premium Rates Provision is modified by revising the first paragraph:
The premium rates may be changed by the Insurance Company from time to time with at least 60 days advance written notice. No change in rates will be made until 12 months after the Effective Date. An increase in rates will not be made more often than once in a 12 month period. However, the Insurance Company reserves the right to change the rates even during a period for which the rate is guaranteed, if any of the following events take place:
9) Under the General Provisions section following changes are made:
a) The Assignment provisions is replaced with the following:
We will be bound by an assignment of a Covered Person's insurance under this Policy only when the original assignment or a certified copy of the assignment, signed by the Covered Person and any irrevocable beneficiary, is filed with Us. The assignee may exercise all rights and receive all benefits assigned only while the assignment remains in effect and insurance under this Policy and the Covered Person’s Certificate remains in force.
b) The Incontestability provision is replaced with the following:
This Policy or Participation Under This Policy In the absence of fraud, all statements made by the Policyholder to obtain this Policy or to participate under this Policy are considered representations and not warranties. No statement will be used to deny or reduce benefits or be used as a defense to a claim, or to deny the validity of this Policy or of participation under this Policy unless a copy of the written instrument containing the statement is, or has been, furnished to the Policyholder.
After two years from the Policy Effective Date, no such statement will cause this Policy to be contested.
A Covered Person's Insurance In the absence of fraud, all statements made by a Covered Person are considered representations and not warranties. No statement will be used to deny or reduce benefits or be used as a defense to a claim, unless a copy of the written instrument containing the statement has been signed by the Covered Person, and is, or has been, furnished to the claimant.
After the insurance has been in force before the contest for two years during the individual’s lifetime, no such statement will cause the insurance to be contested except for fraud or lack of eligibility for insurance.
In the event of death or incapacity, the beneficiary or personal representative shall be given a copy.
c) The Policy Termination provision is replaced with the following:
We may terminate insurance on or after the first anniversary of the Policy Effective Date. The Policyholder may terminate insurance on any Premium Due Date. Written notice by certified mail must be given at least 31 days prior to such Premium Due Date. Failure by the Policyholder to pay premiums when due or within the Grace Period shall be deemed notice to Us to terminate insurance at the end of the Grace Period. Termination will not affect a claim for a Covered Loss that is the result, directly and independently of all other causes, of a loss that occurs while coverage was in effect. Termination of the Policy during a period of disability of the Employee will not affect benefits payable under the coverage for loss of time from work because of the disability, or any specific indemnity required to be provided during a period of Hospital confinement.
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