Acts and Regulations

I-12 - Insurance Act

Section 191.1
Disposition versions

Full text
Contract of group insurance or benefit provision in contract of group insurance terminated
191.1(1)In this section
“original maximum benefit period” means, in respect of a contract of group insurance, the maximum period provided under the contract for the payment of any benefit payable under the contract in respect of loss of income;(période maximale d’origine des prestations)
“prescribed time period” means, in respect of a contract of group insurance, a continuous period of six months following the termination of the contract or a benefit provision in the contract or such longer continuous period as may be provided in the contract.(période de temps prescrite)
191.1(2)When a contract of group insurance or a benefit provision in a contract of group insurance is terminated, the insurer continues, as though the contract or benefit provision had remained in full force and effect, to be liable to pay to or in respect of any group person insured under the contract benefits under the contract relating to
(a) loss of income because of disability,
(b) death, or
(c) dismemberment,
arising from an accident or sickness that occurred before the termination of the contract or benefit provision, if the disability, death or dismemberment is reported to the insurer within the prescribed time period.
191.1(3)Notwithstanding subsection (2), an insurer does not remain liable under a contract or benefit provision described in that subsection to pay a benefit for loss of income for the recurrence after the termination of that contract or benefit provision of a disability that recurs after a continuous period of six months, or such longer period as may be provided in the contract, during which the group person insured was not disabled.
191.1(4)An insurer who is liable under subsection (2) to pay a benefit for loss of income as a result of the disability of a group person insured is not liable to pay benefits for any period longer than the remaining portion of the original maximum benefit period in respect of the disability of the group person insured.
191.1(5)If a contract of group insurance, in this subsection called the “replacement contract”, is entered into within thirty-one days after the termination of another contract of group insurance, in this subsection called the “other contract”, and insures the same group or part of the group insured under the other contract,
(a) the replacement contract shall provide or shall be deemed to provide that any person who was insured under the other contract at the time of its termination is insured under the replacement contract from and after the termination of the other contract if
(i) the insurance on that person under the other contract terminated solely by reason of the termination of the other contract, and
(ii) the person is a member of a class eligible for insurance under the replacement contract,
(b) every person who was insured under the other contract and who is insured under the replacement contract is entitled to receive credit for satisfaction of any deductible earned before the effective date of the replacement contract, and
(c) no person who was insured under the other contract shall be excluded from eligibility under the replacement contract solely because of not being actively at work on the effective date of the replacement contract,
but if the replacement contract provides that the full benefits required to be paid under subsection (2) by the insurer of the other contract are to be paid instead under the replacement contract, the insurer of the other contract is not liable to pay those benefits.
1989, c.16, s.1
Accident and sickness insurance
191.1(1)In this section
“original maximum benefit period” means, in respect of a contract of group insurance, the maximum period provided under the contract for the payment of any benefit payable under the contract in respect of loss of income;
“prescribed time period” means, in respect of a contract of group insurance, a continuous period of six months following the termination of the contract or a benefit provision in the contract or such longer continuous period as may be provided in the contract.
191.1(2)When a contract of group insurance or a benefit provision in a contract of group insurance is terminated, the insurer continues, as though the contract or benefit provision had remained in full force and effect, to be liable to pay to or in respect of any group person insured under the contract benefits under the contract relating to
(a) loss of income because of disability,
(b) death, or
(c) dismemberment,
arising from an accident or sickness that occurred before the termination of the contract or benefit provision, if the disability, death or dismemberment is reported to the insurer within the prescribed time period.
191.1(3)Notwithstanding subsection (2), an insurer does not remain liable under a contract or benefit provision described in that subsection to pay a benefit for loss of income for the recurrence after the termination of that contract or benefit provision of a disability that recurs after a continuous period of six months, or such longer period as may be provided in the contract, during which the group person insured was not disabled.
191.1(4)An insurer who is liable under subsection (2) to pay a benefit for loss of income as a result of the disability of a group person insured is not liable to pay benefits for any period longer than the remaining portion of the original maximum benefit period in respect of the disability of the group person insured.
191.1(5)If a contract of group insurance, in this subsection called the “replacement contract”, is entered into within thirty-one days after the termination of another contract of group insurance, in this subsection called the “other contract”, and insures the same group or part of the group insured under the other contract,
(a) the replacement contract shall provide or shall be deemed to provide that any person who was insured under the other contract at the time of its termination is insured under the replacement contract from and after the termination of the other contract if
(i) the insurance on that person under the other contract terminated solely by reason of the termination of the other contract, and
(ii) the person is a member of a class eligible for insurance under the replacement contract,
(b) every person who was insured under the other contract and who is insured under the replacement contract is entitled to receive credit for satisfaction of any deductible earned before the effective date of the replacement contract, and
(c) no person who was insured under the other contract shall be excluded from eligibility under the replacement contract solely because of not being actively at work on the effective date of the replacement contract,
but if the replacement contract provides that the full benefits required to be paid under subsection (2) by the insurer of the other contract are to be paid instead under the replacement contract, the insurer of the other contract is not liable to pay those benefits.
1989, c.16, s.1