Health Care Services and Financing

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

Laws that prohibit exclusion of insurance claims arising from intoxication of the insured.

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

APIS classifies each jurisdiction's statutes and regulations in the following two categories that, depending on the type of insurance benefit analyzed, may not be mutually exclusive.

  • Denial of Health Insurance Benefits Specifically PERMITTED
  • Statutes and regulations related to health insurance that use the standard exclusionary language found in the NAIC model law or a variation with the same legal effect.
  • Denial of Health Insurance Benefits Specifically PROHIBITED
  • Statutes and regulations related to health insurance that require insurance policies to pay benefits for covered losses sustained or contracted in consequence of the insured's being intoxicated or under the influence of alcohol (instead of permitting insurers to deny such coverage).  In other words, insurers in jurisdictions with this provision are liable for loss even if the insured was intoxicated or under the influence.