3923.24 Continuing coverage for dependent children.

Every certificate furnished by an insurer in connection with, or pursuant to any provision of, any group sickness and accident insurance policy delivered, issued for delivery, renewed, or used in this state on or after January 1, 1972, and every policy of sickness and accident insurance delivered, issued for delivery, renewed, or used in this state on or after January 1, 1972, which provides that coverage of an unmarried dependent child will terminate upon attainment of the limiting age for dependent children specified in the contract shall also provide in substance that attainment of such limiting age shall not operate to terminate the coverage of such child if the child is and continues to be both:

(A) Incapable of self-sustaining employment by reason of mental retardation or physical handicap;

(B) Primarily dependent upon the policyholder or certificate holder for support and maintenance.

Proof of such incapacity and dependence shall be furnished by the policyholder or by the certificate holder to the insurer within thirty-one days of the child’s attainment of the limiting age. Upon request, but not more frequently than annually after the two-year period following the child’s attainment of the limiting age, the insurer may require proof satisfactory to it of the continuance of such incapacity and dependency.

Nothing in this section shall require an insurer to cover a dependent child who is mentally retarded or physically handicapped if the contract is underwritten on evidence of insurability based on health factors set forth in the application, or if such dependent child does not satisfy the conditions of the contract as to any requirement for evidence of insurability or other provision of the contract, satisfaction of which is required for coverage thereunder to take effect. In any such case, the terms of the contract shall apply with regard to the coverage or exclusion of the dependent from such coverage. Nothing in this section shall apply to accidental death or dismemberment benefits provided by any such policy of sickness and accident insurance.

Effective Date: 12-20-1971