376.717. Coverages provided, persons covered--coverage not provided, when--maximum benefits allowable.
Coverages provided, persons covered--coverage not provided,when--maximum benefits allowable.
376.717. 1. Sections 376.715 to 376.758 shall providecoverage for the policies and contracts specified in subsection 2of this section:
(1) To persons who, regardless of where they reside, exceptfor nonresident certificate holders under group policies orcontracts, are the beneficiaries, assignees or payees of thepersons covered under subdivision (2) of this subsection; and
(2) To persons who are owners of or certificate holdersunder such policies or contracts and who:
(a) Are residents of this state; or
(b) Are not residents, but only under all of the followingconditions:
a. The insurers which issued such policies or contracts aredomiciled in this state;
b. Such insurers never held a license or certificate ofauthority in the states in which such persons reside;
c. Such states have associations similar to the associationcreated by sections 376.715 to 376.758; and
d. Such persons are not eligible for coverage by suchassociations.
2. Sections 376.715 to 376.758 shall provide coverage tothe persons specified in subsection 1 of this section for direct,nongroup life, health, annuity and supplemental policies orcontracts, certificates under direct group policies andcontracts, except as limited by the provisions of sections376.715 to 376.758.
3. Sections 376.715 to 376.758 shall not provide coveragefor:
(1) Any portion of a policy or contract not guaranteed bythe insurer, or under which the risk is borne by the policy orcontract holder;
(2) Any policy or contract of reinsurance, unlessassumption certificates have been issued;
(3) Any portion of a policy or contract to the extent thatthe rate of interest on which it is based:
(a) Averaged over the period of four years prior to thedate on which the association becomes obligated with respect tosuch policy or contract, exceeds the rate of interest determinedby subtracting three percentage points from Moody's CorporateBond Yield Average averaged for that same four-year period or forsuch lesser period if the policy or contract was issued less thanfour years before the association became obligated; and
(b) On and after the date on which the association becomesobligated with respect to such policy or contract exceeds therate of interest determined by subtracting three percentagepoints from Moody's Corporate Bond Yield Average as most recentlyavailable;
(4) Any plan or program of an employer, association orsimilar entity to provide life, health, or annuity benefits toits employees or members to the extent that such plan or programis self-funded or uninsured, including but not limited tobenefits payable by an employer, association or similar entityunder:
(a) A "multiple employer welfare arrangement" as defined insection 514 of the Employee Retirement Income Security Act of1974, as amended;
(b) A minimum premium group insurance plan;
(c) A stop-loss group insurance plan; or
(d) An administrative services only contract;
(5) Any portion of a policy or contract to the extent thatit provides dividends or experience rating credits, or providesthat any fees or allowances be paid to any person, including thepolicy or contract holder, in connection with the service to oradministration of such policy or contract; and
(6) Any policy or contract issued in this state by a memberinsurer at a time when it was not licensed or did not have acertificate of authority to issue such policy or contract in thisstate.
4. The benefits for which the association may become liableshall in no event exceed the lesser of:
(1) The contractual obligations for which the insurer isliable or would have been liable if it were not an impaired orinsolvent insurer; or
(2) With respect to any one life, regardless of the numberof policies or contracts:
(a) Three hundred thousand dollars in life insurance deathbenefits, but not more than one hundred thousand dollars in netcash surrender and net cash withdrawal values for life insurance;
(b) One hundred thousand dollars in health insurancebenefits, including any net cash surrender and net cashwithdrawal values;
(c) One hundred thousand dollars in the present value ofannuity benefits, including net cash surrender and net cashwithdrawal values.
Provided, however, that in no event shall the association beliable to expend more than three hundred thousand dollars in theaggregate with respect to any one life under paragraphs (a), (b),and (c) of this subdivision.
(L. 1988 S.B. 430 § 3)