The amount of benefits payable, or any term, condition, or
type of coverage may not be restricted, modified, excluded, or reduced on the
basis of the sex or marital status of the insured or prospective insured.
However, nothing in these sections shall prohibit an insurer from taking
marital status into account for the purpose of defining persons eligible for
dependents' benefits. Specific practices prohibited by this section shall
include, but not be limited to, the following.
(1) No policy may treat complications of
pregnancy differently than any other illness or sickness under the policy. For
the purpose of this section, complications of pregnancy means:
(A) conditions, requiring hospital
confinement (when the pregnancy is not terminated), whose diagnoses are
distinct from pregnancy but are adversely affected by pregnancy or are caused
by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation,
missed abortion, and similar medical and surgical conditions of comparable
severity, but shall not include false labor, occasional spotting, physician
prescribed rest during the period of pregnancy, morning sickness, hyperemesis
gravidarum, pre-eclampsis, and similar conditions associated with the
management of a difficult pregnancy not constituting a nosologically distinct
complication of pregnancy; and
(B)
non-elective cesarean section, termination of ectopic pregnancy, and
spontaneous termination of pregnancy, occurring during a period of gestation in
which a viable birth is not possible.
(2) No policy may restrict, reduce, modify,
or exclude benefits based solely upon the genital organs of one sex.
(3) No policy may apply arbitrary waiting
periods to maternity benefits in such a way as to exclude coverage for
premature births when normal maternity benefits are included in the policy.
Medical evidence of the prematurity of the baby may reasonably be
required.
(4) No disability policy
may offer lower maximum monthly benefits to women than to men who are in the
same risk classifications.
(5) No
disability policy may offer more restrictive basic benefit periods or more
restrictive definitions of disability to women than to men. Normal pregnancy is
not considered to be a disability.
(6) No policy may establish different
conditions by sex as a prerequisite to the exercise of benefit options
contained in the policy.
(7) No
insurer may limit the scope and/or amount of coverage an insured or prospective
insured may purchase based on the insured's or prospective insured's marital
status unless such limitation is for the purpose of defining persons eligible
for dependents' benefits.
