§ 2220.11. Loss-of-Time Generally.

STANDARDS

A loss-of-time benefit provided by a policy shall be deemed not sufficient to be of real economic value to the insured if:

(a) Its amount is less than:

(1) $100 per month payable at ages up to 62 and $50 per month payable at ages after 62; except

(2) In the case of industrial insurance or insurance issued to cover persons not gainfully employed, if its amount is less than $60 per month payable at ages up to 62 and $30 per month payable after age 62; or

(b) Its elimination period, if any, exceeds:

(1) 90 days in the case of a policy which provides a benefit period of one year or less; or

(2) 365 days if the benefit is payable for not less than two years and is payable in an amount less than $200 per month; or

(3) 180 days in all other cases.

(c) The maximum period of time for which it is payable during disability, other than as specified in Subsection (b) of this section, is less than:

Six months, except in the case of such a benefit payable for disability arising out of pregnancy, childbirth or miscarriage the benefit period may be one month.

Subsection (a) of this section shall not apply to additional loss-of-time benefits issued by the same insurer by rider or issued by the same insurer under guaranteed insurability or future purchase option provisions which are part of the policy or benefits issued by application of a cash dividend. The Commissioner may, in accordance with the provision of Section 2220.7, in his discretion, approve other loss-of-time benefits designed and actually programmed to supplement continuance programs, California Unemployment Compensation Disability benefits and Social Security total disability benefits.

The phrase “actually programmed” as used in this section and in Section 2220.15, means an insurance program designed for a specific person in a person to person face to face interview with the individual insured or prospective insured by an insurance agent or broker.