Health Insurance: Losses due to Intoxication (“UPPL”)

Section designations in the District of Columbia Code were renumbered in connection with the publication of the D.C. Official Code, 2001 Edition.

The prohibition in Section 514A.3 prohibits intoxication exclusions in a "medical expense policy," which is defined as an "accident and sickness insurance policy that provides hospital, medical, and surgical expense coverage." Intoxication exclusions are not expressly prohibited in other types of "accident and sickness insurance policies," such as an accident insurance policy that provides for fixed sum payments or wage replacement.

Pursuant to Me. Rev. Stat. Ann. tit. 24-A, §§ 2701, 2728, intoxication exclusions are prohibited in “health insurance contracts” with the exception that they are permitted in “group or blanket” policies.

Between October 30, 2000, and December 31, 2001, intoxication exclusions were permitted by statute in individual health insurance policies but were prohibited by regulation in group health insurance policies, individual and group health maintenance contracts, and individual nonprofit health service plans. Effective January 1, 2002, the statute permitting intoxication exclusions in individual health insurance policies was repealed and a regulation was promulgated prohibiting such exclusions. The regulations prohibiting exclusions in group health insurance policies, individual and group health maintenance contracts, and individual nonprofit health service plans remained in effect.

The prohibition in N.C. Gen. Stat. s. 58-51-16 prohibits intoxication exclusions in a
"medical expense policy," which means an "accident and health insurance policy that provides hospital, medical, and surgical expense coverage." Intoxication exclusions are not expressly prohibited in other types of "accident and health insurance policies," such as an accident insurance policy that provides for fixed sum payments or wage replacement.

In 2005, Rhode Island amended its UPPL law through two enacted bills, each having a different effective date. 2005 R.I. Pub. Laws 48 became effective on June 16, 2005, and 2005 R.I. Pub. Laws 58 became effective on June 23, 2005.