Common use of Exclusion from Coverage Clause in Contracts

Exclusion from Coverage. 1. A person who holds a direct non-group life, health, health maintenance organization, or annuity policy or contract, a certificate under a direct group policy or contract for a supplemental contract to any of these, or an unallocated annuity contract is not protected by LLHIGA if: a. he is eligible for protection under the laws of another state; b. the insurer was not authorized to do business in this state; c. his policy was issued by a profit or nonprofit hospital or medical service organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, an insurance exchange, an organization that issues charitable gift annuities as is defined by law, or any entity similar to any of these. 2. LLHIGA also does not provide coverage for: a. any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; b. any policy of reinsurance (unless an assumption certificate was issued); c. interest rate or crediting rate yields, or similar factors employed in calculating changes in value, that exceed an average rate; d. dividends, premium refunds, or similar fees or allowances described under the law; e. credits given in connection with the administration of a policy by a group contract holder; f. employers’, associations’ or similar entities’ plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them) or uninsured; g. unallocated annuity contracts (which give rights to group contract holders, not individuals), except if qualified by law h. an obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the policy owner or contract owner, including but not limited to, claims described under the law; i. a policy or contract providing any hospital, medical, prescription drug or other health care benefits pursuant to “Medicare Part A coverage”, “Medicare Part B coverage”, “Medicare Part C coverage”, or “Medicare Part D coverage” and any regulations issued pursuant to those parts; j. interest or other changes in value to be determined by the use of an index or other external references but which have not been credited to the policy or contract or as to which the policy or contract owner’s rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer, whichever is earlier.

Exclusion from Coverage. 1. A person who holds a direct non-group life, health, health maintenance organization, or annuity policy or contract, a certificate under a direct group policy or contract for a supplemental contract to any of these, or an unallocated annuity contract is not protected by LLHIGA if: a. he is eligible for protection under the laws of another state; b. the insurer was not authorized to do business in this state; c. his policy was issued by a profit or nonprofit hospital or medical service organization, a fraternal benefit society, a mandatory state pooling plan, a mutual assessment company or similar plan in which the policyholder is subject to future assessments, an insurance exchange, an organization that issues charitable gift annuities as is defined by law, or any entity similar to any of these. . 23XX0534 R08/18 1 2. LLHIGA also does not provide coverage for: a. any policy or portion of a policy which is not guaranteed by the insurer or for which the individual has assumed the risk, such as a variable contract sold by prospectus; b. any policy of reinsurance (unless an assumption certificate was issued); c. interest rate or crediting rate yields, or similar factors employed in calculating changes in value, that exceed an average rate; d. dividends, premium refunds, or similar fees or allowances described under the law; e. credits given in connection with the administration of a policy by a group contract holder; f. employers’, associations’ or similar entities’ plans to the extent they are self-funded (that is, not insured by an insurance company, even if an insurance company administers them) or uninsured; g. unallocated annuity contracts (which give rights to group contract holders, not individuals), except if qualified by law h. an obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the policy owner or contract owner, including but not limited to, claims described under the law; i. a policy or contract providing any hospital, medical, prescription drug or other health care benefits pursuant to “Medicare Part A coverage”, “Medicare Part B coverage”, “Medicare Part C coverage”, or “Medicare Part D coverage” and any regulations issued pursuant to those parts; j. interest or other changes in value to be determined by the use of an index or other external references but which have not been credited to the policy or contract or as to which the policy or contract owner’s rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer, whichever is earlier.