31.10.25.06

.06 Optional Provisions.

A. A carrier may include any of the optional provisions described in §§C—G of this regulation.

B. A carrier may not include an optional provision dealing with the same subjects set forth in C—G of this regulation if the provision is drafted in a manner that is less favorable to the subscriber or any covered individual than the corresponding optional provision set forth in C—G of this regulation.

C. Physical Examination.

(1) A carrier may include a provision in an individual contract giving the carrier the right to examine the covered individual when and as often as it may reasonably require during the pendency of a claim under the contract.

(2) If the carrier includes the provision described in C(1) of this regulation, the provision shall indicate that any physical examination required by the carrier will be performed at the expense of the carrier.

D. Autopsy.

(1) A carrier may include a provision in an individual contract giving the carrier the right to make an autopsy in case of death when an autopsy is not forbidden by law.

(2) If the carrier includes the provision described in D(1) of this regulation, the provision shall indicate that any autopsy required by the carrier will be performed at the expense of the carrier.

E. Misstatement of Age. An individual contract may contain the following provision: "Misstatement of age: If the age of the covered individual has been misstated, all amounts payable under this contract shall be such as the premium would have purchased at the correct age."

F. Unpaid Premiums. An individual contract may contain in substance the following provision: "Unpaid premiums: Upon the payment of a claim under this contract, any premium then due and unpaid or covered by any note or written order may be deducted from the claim payment."

G. Arbitration.

(1) A carrier may include a provision in an individual contract giving the covered individual the option of entering binding arbitration to settle a dispute with the carrier.

(2) If the carrier includes the provision described in G(1) of this regulation, the provision may not require the covered individual to enter binding arbitration.