Opinion
The dispositive issue in this case, which comes to us upon our acceptance of two certified questions from the United States Court of Appeals for the Second Circuit pursuant to General Statutes § 51-199b (d), is whether the “entire contract” clause of General Statutes § 38a-483 (a) (l) 1 prohibits an insurer from *14 incorporating by reference its underwriting income rules 2 described in a future increase option rider to a disability insurance policy, when the application of those rules can neither decrease nor eliminate a fixed benefit of the original policy. We answer that question in the negative.
The plaintiff, Charles M. Parrot, commenced this breach of contract action in the United States District Court for the District of Connecticut after the defendant, The Guardian Life Insurance Company of America (Guardian), denied his request to obtain the maximum amount of insurance available under a future increase option rider to an existing disability insurance policy. In that proceeding, Parrot contended, inter alia, 3 that the income rules that Guardian had used to calculate the monthly benefit to which he was entitled were void because they were not appended to the rider to his policy as required by § 38a-483 (a) (1). The District Court rendered judgment as a matter of law for Guardian, from which Parrot appealed to the Second Circuit Court of Appeals. That court then certified two questions to us, which we have agreed to answer. 4
*15 The record certified by the Second Circuit Court of Appeals reveals the following relevant facts and procedural history. In 1988, Parrot, a medical doctor, pm-chased a disability insurance policy from Guardian that provided for the payment of monthly benefits if he should become partially or totally disabled. The policy included a future increase option rider that gave Parrot thе right to purchase an additional insurance policy on each anniversary date of his original policy at terms offered to new insureds at that time, regardless of any intervening changes to his health or occupation. The future increase option rider, together with the attached schedule of benefits, stated that the maximum monthly indemnity amount that Parrot could purchase on all option dates combined was $6000. Although this term established a cap on the optional coverage, the precise amount of coverage that Parrot could purchase was limited by Guardian’s underwriting income rules, which were referenced in the rider but not appended thereto. Specifically, the rider stated: “The monthly indemnity of the option plan . . . may not exceed our published income rules for new insureds. These rules limit the total insurance which we will issue in relation to earned income. 5 We will use the rules that applied on the date of issue of this policy, unless more liberal rules are then in effect.” Parrot’s policy, to which the rider was attached, also contained the “entire contract” provision mandated by § 38a-483 (a) (1). The relevant provision in Parrot’s policy provides: “This policy, with its riders and attached papers, if any, is the entire contract of *16 insurance. No change in this policy will be valid unless it has been endorsed on or attached to this policy in writing by the president, a vice president, or the secretary of Guardian.”
In 1995, Parrot became partially disabled and Guardian began paying monthly benefits to him. One year later, Parrot became totally disabled and Guardian adjusted his monthly benefit upward to $3000, the full monthly indemnity allowed under his original policy. On the 1995 anniversary date, Parrot exercised his future increase option and submitted his tax returns and other financial records to Guardian for use in calculating the additional coverage that he was eligible to obtain under the terms of the future increase option rider. On the basis of those records, Guardian calculated Parrot’s average monthly rate of earnings during the twelve months preceding his disability. Guardian then applied its most liberal income rules to that earnings figure and determined that Parrot was qualified to receive an additional benefit of $1600 per month. 6 On December 19,1995, Guardian issued to Parrot a second insurance policy specifying an indemnity in that amount.
Parrot’s dissatisfaction with Guаrdian’s calculation prompted him to file a diversity action against Guardian in federal District Court. Parrot alleged that Guardian had breached the terms of its insurance contract with him and demanded that the company raise his monthly benefits under the 1995 contract to $6000, the maximum set forth in the schedule of benefits, to which the future increase option rider refers. According to Parrot, such a remedy was appropriate because the income rules were not appended to the original policy, and, consequently, were invalid under § 38a-483 (a) (1). Parrot *17 also contended that Guardiаn had misinterpreted the contract term “rate of earnings when you first became disabled,” which drives the incremental amount of insurance that Guardian will underwrite to its disabled policyholders in accordance with its published income rules. See footnote 3 of this opinion. Following the close of evidence after a jury trial, the District Court granted Guardian’s motion for judgment as a matter of law on both issues and rendered judgment thereon in favor of Guardian.
Parrot appealed from that judgment to the Second Circuit Court of Appeals. Following oral ar gument by the parties, the Court of Appeals determined that Parrot’s claim implicates “an important question of Connecticut insurance law” that involves the application of § 38a-483 (a) (1).
Parrot
v.
Guardian Life Ins. Co. of America,
“(2) In the event that the unappended income rules are void under § 38a-483 (a) (1), what is the proper remedy in this case?” Id., 145.
Resolution of the first certified question involves an issue of statutory interpretation over which we exercise plenary review. See, e.g.,
Perodeau
v.
Hartford,
Connecticut has enacted a statute that requires insurers to incorporate certain standard provisions in individual health insurance policies, including those providing disability income protection. 7 See generally General Statutes § 38a-483 (a). Subdivision (1) of § 38a-483 (a) requires the inclusion of the following clause: “ENTIRE CONTRACT: CHANGES: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.” (Emphasis added; internal quotation marks omitted.)
Neither party disputes the meaning of the “entire contract” clause embodied in § 38a-483 (a) (1). It requires an insurer that issues individual health insurance policies to insert in each such policy a clause stating that all of the policy terms and conditions are included in the issued contract of insurance. This statutory provision benefits a policyholder in two ways. First, it ensures that the policyholder is apprised of his or her rights and obligations under an issued policy. Second, it promotes certainty in the contract by requiring an insurer to establish the terms and conditions of the policy on thе date of its issuance. See
Sanghavi
v.
Paul Revere Life Ins. Co.,
supra,
The arguments advanced by Parrot and Guardian center on the applicability of the “entire contract” clause of § 38a-483 (a) (1) to the facts of the present case in *20 light of our interpretation of the predecessor to that statute in Sanghavi. See id., 307-308 (interpreting General Statutes [Rev. to 1989] § 38-167). Specifically, Parrot contends that, under the reasoning of Sanghavi, the income condition described in the future increase option rider must be deemed invalid because the income rules to which the rider refers were not appended to the 1988 policy that included the rider. Guardian responds that Sanghavi is not controlling in this case because the policy at issue in Sanghavi and the policy at issue in the present case are factually distinguishable. We agree with Guardian.
The language of the statute makes clear that the “entire contract” clause was designed to protect policyholders once a policy is “delivered or issued for delivery . . . .” (Emphasis added.) General Statutes § 38a-483 (a). That prerequisite leads us to conclude that a crucial distinction between Sanghavi and the present case is that, in the former case, the income rules affected the benefits payablе under an existing policy that had been issued and delivered to the policyholder. The rider at issue in the present case, by contrast, provided that Guardian would apply its income rules to underwrite a wholly separate policy in the future. Because the income rules referenced in Parrot’s rider did not affect the benefits payable under an existing policy that had been issued and delivered to Parrot, § 38a-483 (a) (1) does not invalidate the income condition described therein.
Sanghavi
involved only one insurance policy. See
Sanghavi
v.
Paul Revere Life Ins. Co.,
supra,
When Parrot purchased his 1988 policy, he obtained two separate insurance products with features that are markedly different from the single policy issued to Sanghavi. Specifically, Parrot purchased the underlying policy that would pay him a maximum benefit of $3000 per month if he became totally disabled. Parrot also purchased an option plan thаt afforded him the right to procure a separate, additional policy in the future on terms at least as favorable as those then offered to new insureds, without regard to any change in Parrot’s health or occupation. 10 Indeed, the option plan makes *23 clear that all of the terms of the new policy would be defined in the future, reserving to Guardian the right to modify its corporate underwriting policies in response to competitive forces in the marketplace. Although the option plan stated that his eligibility to purchase an additional policy would be subject to the limitations imposed by Guardian’s income rules, Parrot’s case differs frоm Sanghavi because the income rules did not affect the benefits payable under Parrot’s original policy, which had been fully underwritten and delivered to Parrot. Rather, the income rules to which the future increase option rider refers merely served to clarify the standard for underwriting a wholly separate policy that may or may not be issued in the future. Thus, Guardian’s application of its income rules under the circumstances of this case simply does not fall within the purview of § 38a-483 (a) (1) in view of our interpretation of its predecessor in Sanghavi. 11
*24 Parrot argues, nevertheless, that the harm that § 38a-483 (a) (1) sеeks to prevent is the insured’s inability to determine the benefits available to him or her under an insurance contract. In order to prevent that harm, Parrot claims that an insurer must not only physically attach the income rules in effect on the date of the rider, but also must provide the policyholder with periodic updates whenever the rules change. Otherwise, Parrot argues, a policyholder will not be able to determine when his or her income might qualify for increased coverage under the terms of the rider. Parrot therefore posits that, if Guardian were allowed to use its unappеnded income rules in order to reduce the $6000 maximum monthly indemnity authorized by the future increase option rider and schedule of benefits, such a result would contravene the legislative intent of the statute. We are not persuaded.
Although we agree that one of the purposes of the statute is to apprise the policyholder of his rights under an insurance contract, we conclude that goal was attained in the present case for two principal reasons. First, the rider in Parrot’s policy, unlike Sanghavi’s policy, provided that Guardian would use the income rules that applied in 1988 unless more liberal rules were in effect on the option date. If Parrot’s income rose, he knew that the amount of incremental coverage that he could obtain would equal, at a minimum, the benefits calculated in accordance with the 1988 income rules. This feature in Parrot’s rider not only promoted certainty in the contract by establishing a floor on the income condition as of the policy issuance date, but also fostered his knowledge of the benefits provided in accordance with the rider.
Second, there is nothing in the language of the statute to support Parrot’s аssertion that the legislature intended to require an insurer to attach physically its underwriting income rules to an increase option rider.
*25
Nor does
Sanghavi
strictly impose such a requirement even when an insurer’s application of its income rules affects the benefits payable under an existing policy. In
Sanghavi,
we noted that the rules were neither appended to Sanghavi’s policy nor made available to him;
Sanghavi
v.
Paul Revere Life Ins. Co.,
supra,
Finally, we note that our decision today is in accord with case law from other jurisdictions that have con
*26
strued state statutes similar to § 38a-483 (a) (1). Of particular significance is
Equitable Life Assurance Society of the United States
v.
Rocanova,
189 App. Div. 2d 660,
The United States District Court for the Eastern District of Pennsylvania reached the same result under analogous facts in
Prousi
v.
UNUM Life Ins. Co. of America,
77 F. Sup. 2d 665 (E.D. Pa. 1999), aff'd,
For the foregoing reasons, we conclude that the answer to the first certified question is: No. The “entire contract” provision of § 38a-483 (а) (1) does not prohibit an insurer from incorporating by reference its underwriting income rules in an increase option rider to a disability insurance policy, when the application of those rules can neither decrease nor eliminate a fixed benefit of the original policy. Consequently, we need not reach the second certified question.
No costs shall be taxed in this court to either party.
In this opinion the other justices concurred.
Notes
General Statutes § 38a-483 (a) provides in relevant part: “[E]ach individual health insurance policy delivered or issued for delivery to any person in this state shall contain the provisions specified in this subsection .... Such provisions to be contained in such policy shall bе:
“(1) A provision as follows: ‘ENTIRE CONTRACT: CHANGES: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval *14 be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.’ . . .” (Emphasis added.)
Income rules, which are also known as issue and participation limits, are established by insurers of disability income protection as an integral part of their underwriting policies. The rules limit thе amount of coverage that a policyholder may purchase to a percentage of the policyholder’s earned income.
In the proceedings before the District Court, Parrot also claimed that Guardian had misconstrued the contract term “rate of earnings when you first became disabled,” which, in conjunction with the income rules, limits the amount of coverage a disabled option holder may purchase. In particular, Parrot argued that such contract term “referred to his earnings in the last month, not to the average of the last twelve months, before he bеcame disabled.”
Parrot
v.
Guardian Life Ins. Co. of America,
The Second Circuit Court of Appeals certified the following two questions to this court: “(1) Does ... § 38a-483 (a) (l)’s requirement that the ‘entire contract’ be provided to the insured prohibit an insurance company from incorporating by reference current and future annual benefit rates, where *15 the insurer can neither decrease nor eliminate a fixed benefit of the original policy?
“(2) In the event that the unappended income rules are void under § 38a-483 (a) (1), what is the proper remedy in this case?”
Parrot
v.
Guardian Life Ins. Co. of America,
A separate poliсy provision defined the term “earned income” for purposes of the option plan as the insured’s “rate of earnings when [the insured] first became disabled under this policy.”
Guardian used its 1995 income rules to calculate Parrot’s eligibility for additional benefits because they were more liberal than the rules in effect in 1988, the year in which Guardian had issued the original policy to Parrot.
General Statutes § 38a-469 (5) includes “disability income protection coverage” in the definition of health insurance policy.
The rider in Sanghavi’s policy provided in relevant part: “INCREASE IN MONTHLY INDEMNITY OPTION. The Company agrees, subject to the terms and conditions hereinafter set forth and while this Benefit and the policy to which it is attached are in force,
to increase, without evidence of physical insurability, the Monthly Indemnity for Total Disability specified in the Policy Schedule of the policy
in an amount equal to the Unit of Monthly Indemnity Increase or portion thereof set forth for this Benefit in the Table of Supplementary Benefits of the Policy Schedule upon each of the Anniversary Option Dates . . . provided ... (2) such Monthly Indemnity Increase together with similar total disability indemnity benefits under
the policy
and all other valid disability income coverage . . . provided by this or any other insurer . . . does not exceed the maximum disability income coverage being offered by the Company to new applicants of the Insured’s classification of risk on the Anniversary Option Date according to the Company’s then published underwriting and participation limits; and (3)
the Insured’s monthly earned income is sufficient to qualify for an increase in Monthly Indemnity on the Anniversary Option Date according to the Company’s then published income limits
. . . .” (Emphasis added; internal quotation marks omitted.)
Sanghavi
v.
Paul Revere Life Ins. Co.,
supra,
General Statutes (Rev. to 1989) § 38-167 (a) provided in relevant part: “[E]ach [accident оr health] policy delivered or issued for delivery to any person in this state shall contain the provisions specified in this subsection . . . . Such provisions to be contained in such policy shall be (1) a provision as follows: ‘ENTIRE CONTRACT: CHANGES: Tins policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any оf its provisions.’ ” (Emphasis added.)
The future increase option rider provides in relevant part: “This rider gives you the right to buy more disability income insurance in future years in spite of any change in your health or occupation. We call the added insurance an option plan.
“The option plan will be on a policy form which is most like this policy then in use in the place where you live.
“The total increase option is shown in the schedule page. This is the maximum amount of monthly indemnity which you may buy under this rider on all option dates combined. Your option date each year is the policy аnniversary.
“You do not have to give evidence of good health. But you must give us details of your income, employment and other insurance in force.
* ** *
“The monthly indemnity of the option plan . . . may not exceed our published income rules for new insureds. These rules limit the total insurance which we will issue in relation to earned income. We will use the rules that applied on the date of issue of this policy, unless more liberal rules are then in effect.
*23 “Premiums of the option plan will be at our rates for your age and class of risk on the option date. . . .” (Emphasis added.)
Parrot also contends that his рolicy with Guardian constitutes a contract of adhesion, and, therefore, the “entire contract” clause of the policy should have been construed against Guardian. See
Rumbin
v.
Utica Mutual Ins. Co.,
At oral argument before this court, Parrot argued that Guardian’s application of its income rules also violated the parol evidence rule because the “entire contract” provision mandated by § 38a-483 (a) (1) is a contract merger clause. Parrot contends that this court’s jurisprudence makes clear that the terms of a written contract containing a merger clause may not be varied or contradicted by extrinsic evidence. See, e.g.,
Tallmadge Bros., Inc.
v.
Iroquois Gas Transmission System, L.P.,
Section 3204 of New York Insurance Law provides in relevant part: “(a) (1) Every policy of life, accident or health insurance, or contract of annuity, delivered or issued for delivery in this state, shall contain the entire contract between the parties, and nothing shall be incorporated therein by reference to any writing, unless a copy thereof is endorsed upon or attached to the policy or contract when issued. . . .” N.Y. Ins. Law § 3204 (a) (1) (McKinney 2000).
The Pennsylvania statute requires insurers to place the following provision into insurance contracts that are delivered or issued for delivery in that state: “Entire Contract; Changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.” (Emphasis added.) Pa. Stat. Ann. tit. 40, § 753 (A) (1) (West 1999); see General Statutes § 38a-483 (a) (1) (containing identical language).
