ALABAMA

62566(8/08)

§         CA 21 58 AL Changes – Split Uninsured Motorists Limits

§         CA 21 59 AL Uninsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

ALASKA

62567(6/03)

§         CA 31 24 AK Split Uninsured and Underinsured Motorists Coverage Limits

§         CA 21 60 AK Uninsured and Underinsured Motorists Coverage

Obtain a signed Notice at renewal.

Neither UM nor UIM coverage is included in the policy. Both coverages may be rejected in their entirety.

UMPD coverage is subject to a $250 deductible.

1.      Reject UM and UIM coverage entirely.

2.      Select UM and UIM coverage at $50,000/$100,000/$25,000 or $125,000 (CSL)

3.      Select UM and UIM coverage at policy limits

4.      Select UM and UIM coverage at a limit that is NOT LESS than $50,000/$100,000/$25,000 or $125,000 (CSL) and not greater than the limits shown on the Notice.

5.      Reject the UMPD and UIMPD coverage and select UMBI and UIMBI coverage at a limit that us NOT LESS than $50,000/$100,000/$25,000 or $125,000 (CSL) and not greater than the limits shown on the Notice.

6.      Reject UMBI and UIMBI coverage and select UMPD and UIMPD coverage at a limit that is NOT LESS than $25,000 and not greater than the limits shown on the Notice.

ARIZONA

68917(6/03)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82778)

§         CA 21 39 AZ Uninsured Motorists Coverage

§         CA 21 40 AZ Underinsured Motorists Coverage
(available on all policies with a written date on or after Sept. 1, 2008)

§         CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82779)

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage at policy limits unless coverage is rejected or a lower limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

3.  Reject UIM coverage entirely

4.  Select UIM coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

ARKANSAS

62569(6/03)

§         §          CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82780)

§         §          CA 21 08 AR Uninsured Motorists Coverage

§         CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82781)

§         CA 21 66 AR Uninsured Motorists Coverage – Property Damage      

§         CA 31 28 AR Underinsured Motorist Coverage                                                                                                           

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UMBI coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a different limit is selected.

UMPD coverage is not  included in the policy and is subject to a $200 deductible.

1.  Reject UM coverage entirely

2.  Select UMBI coverage at  $25,000/$50,000 or $50,000 (CSL)

3.  Select UMBI coverage at policy limits

4.  Select UMBI coverage at a limit NOT LESS than 25,000/$50,000  or $50,000 (CSL) and NOT GREATER than policy limits

5.  Reject UMPD coverage entirely

6.  Select UMPD coverage at a limit that is NOT LESS than 25,000 and NOT GREATER than policy limits

CALIFORNIA

62570(7/08)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82782)

§         CA 21 54 CA Uninsured Motorists Coverage – Bodily Injury

§         CA 21 55 CA Uninsured Motorists Coverage – Property Damage

Obtain a signed Notice at renewal.

Coverage provided under a UM endorsement can be offered with limits equal to the underlying policy’s limits of liability for bodily injury, but it is not required that the limits be greater than $30,000/$60,000 or $60,000 (CSL)  The limits may not be less than $15,000/$30,000 or $30,000 (CSL) 

Neither UMPD nor Waiver of Deductible coverages are included in the policy.

1.  Reject UM coverage entirely

2.  Reject UM coverage with respect to individual drivers.

3.  Coverage provided under a UM endorsement can be offered with limits equal to the underlying policy’s limits of liability for bodily injury, but it is not required that the limits be greater than $30,000/$60,000 or $60,000 (CSL)  The limits may not be less than $15,000/$30,000 or $30,000 (CSL) 

4.  Reject UMPD

5.  Select UMPD for vehicles without collision coverage (if UM coverage is not rejected)

6.  Select UMPD for vehicles without collision coverage (if UM coverage is not rejected) except with respect to individual drivers

7.  Reject Waiver of Deductible coverage

8.  Select Waiver of Deductible coverage where collision coverage is provided subject to a deductible

9.  Select Waiver of Deductible coverage where collision coverage is provided subject to a deductible except with respect to individual drivers

COLORADO

62751(3/08)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82783)

§         CA 21 50 CO Uninsured Motorists Coverage – Bodily Injury

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

3.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than  the policy's bodily injury limit.

CONNECTICUT

63582(6/03)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82784)

§         CA 21 57 CT Uninsured and Underinsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UIM coverage at in the amount of $20,000/$40,000 or $40,000 (CSL) unless a higher limit is selected.

UIMC coverage (UIM coverage that is not reduced by payments from any source) is not included in the policy.

1.  Select UIM coverage at double policy limits

2.  Select UIM coverage at policy limits

3.  Select UIM coverage at other limits identified on the Notice

4.  Select UIMC coverage at double policy limits

5.  Select UIMC coverage at policy limits

6.  Select UIMC coverage at other limits identified on the Notice

DELAWARE

62572(6/03)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82785)

§         CA 21 10 DE Uninsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $15,000/$30,000/$10,000 or $40,000 (CSL) unless coverage is rejected or a higher limit is selected.

UMPD coverage is subject to a $250 deductible.

1   Reject UM coverage entirely

2   Select UM coverage at $15,000/$30,000/$10,000 or $40,000 (CSL)
3   Select UM coverage at a limit that is NOT LESS than $15,000/$30,000/$10,000 or $40,000 (CSL) and NOT GREATER than  $100,000/$300,000/$100,000 or $300,000 (CSL)

1.    

DISTRICT OF COLUMBIA

63583(6/03)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82786)

§         CA 21 49 DC Uninsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy. However, the insured must be notified annually, prior to renewal, of the different levels of UM and UIM coverage available.

All policies include  UM coverage in the amount of $25,000/$50,000/$5,000 or $55,000 (CSL) unless a higher limit is selected.

UIM coverage is not included in the policy.

UMPD coverage is subject to a $200 deductible.

1.  Select UM coverage at  $25,000/$50,000/$5,000 or $55,000 (CSL)

2.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$5,000 or $55,000 (CSL) and NOT GREATER than $100,000/$300,000/$25,000 or $325,000 (CSL)

3.  Reject UIM coverage entirely

4.  Select UIM coverage at a limit equal to the UM limit selected

FLORIDA

62574(6/03)

§         §  CA 21 47 FL Uninsured Motorists Coverage -  Stacked

§         §  CA 21 72 FL Uninsured Motorists Coverage - Non-Stacked

§         §  CA 21 73 FL Split Uninsured Motorists Coverage Limits Stacked

§         §  CA 21 02 FL Split Bodily Injury Uninsured Motorists Coverage Limit

§          

Provide the Notice at renewal so that it is part of and attached to the notice of renewal premium.

All policies include UM coverage at policy limits unless coverage is rejected or a lower limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at a limit that is NOT LESS than $10,000/$20,000 or $20,000 (CSL) and NOT GREATER than policy limits

3.  Select UM coverage at policy limits

4.  Elect UM coverage with Non-Stacked Limits

GEORGIA

62586(1/09)

§         CA 21 11 GA Uninsured Motorists Coverage Reduced by At Fault Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000/$25,000 or $75,000 (CSL) unless coverage is rejected or  a higher limit is selected.

1.  1  Reject UM coverage entirely

2.  2  Select UM coverage – Added on to At-Fault Liability Limits

3.  3  Reject UM coverage – Added on to At-Fault Liability Limits and Select UM coverage – Reduced by At-Fault Liability Limits

4.  4  Select UM coverage at 25,000/$50,000/$25,000 or $75,000 (CSL)

5.  5  Select UM coverage at policy limits

6.  6  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$25,000 or $75,000 (CSL) and NOT GREATER than policy limits

7.  7  Reject application of a deductible

8.  8  Request additional information about a deductible

HAWAII

62587(6/03)

§         § CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82787)

§         CA 21 46 Split Underinsured Motorists Coverage Limits  (Chartis US Form No. 82788)

§         CA 21 84 HI Uninsured Motorists Coverage  (Non-Stacked)

§         CA 21 85 HI Underinsured Motorists Coverage (Non-Stacked)

§         CA 31 10 HI Uninsured Motorists Coverage (Stacked)

§         CA 31 11 HI Underinsured Motorists Coverage (Stacked)

§         CA 31 21 HI Split Uninsured Motorists Coverage Limits (Stacked)

§         CA 31 22 HI Split Underinsured Motorists Coverage Limits (Stacked)

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include Stacked UM coverage in the amount of $20,000/$40,000 or $40,000 (CSL) unless coverage is rejected or a higher limit is selected.

UIM coverage is not included in the policy.

1.  Reject UM coverage entirely

2.   2    Select UM coverage at $20,000/$40,000  or $40,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $20,000/$40,000  or $40,000  (CSL) and NOT GREATER than the policy  limits

5.  Select stacked UM limits

6.  Reject stacked UM limits

7.  Reject UIM coverage entirely

8.   Select UIM coverage at $20,000/$40,000  or $40,000 (CSL)

9.  Select UIM coverage at policy limits

10.          Select UIM coverage at a limit that is NOT LESS than $20,000/$40,000  or $40,000  (CSL) and NOT GREATER than the policy  limits

11.          Select stacked UIM limits

12.          Reject stacked UIM limits

IDAHO

62588(1/09)

§         § CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82789)

§          CA 31 15 ID Uninsured Motorists Coverage

§ CA 31 18 ID Underinsured Motorists Coverage Endorsement

§ CA 21 46  Split Underinsured Motorists Coverage Limits Endorsement

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

5.  5  Reject UIM coverage entirely

6.  6  Select UIM coverage at $25,000/$50,000 or $50,000 (CSL)

7.  7  Select UIM coverage at policy limits

8.  8  Select UIM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

ILLINOIS

63584(9/10)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82790)

§         CA 21 30 IL Uninsured Motorists Coverage

§         CA 21 38 IL Underinsured Motorists Coverage

§         CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82791)

§         CA 21 53 IL Uninsured Motorists Coverage – Property Damage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UMBI and UIMBI coverage in the amount of $20,000/$40,000 or $40,000 (CSL) unless coverage is rejected or a higher limit is selected.

UMPD coverage is not included in the policy.  UMPD coverage is subject to a $250 deductible.

1.  Select UMBI and UIMBI coverage at $20,000/$40,000 or $40,000 (CSL)

2.  Select UMBI and UIMBI coverage at policy limits

3.  Select UMBI and UIMBI coverage at a limit that is NOT LESS than $20,000/$40,000 or $40,000 (CSL) and NOT GREATER than policy limits

4.  Reject UMPD

5.  Select UMPD coverage at a limit that is THE LESSER of the actual cash value of the vehicle or $15,000

INDIANA

62589(9/10)

§         CA 21 44 Uninsured Motorists Coverage Limits

§         CA 21 44 Split Uninsured Motorists Coverage Limits

§         CA 2010 003 Indiana UM-UIM

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

 All policies include UM and UIM coverage in the amount of $25,000/$50,000 /$10,000 or $60,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.       Reject UM coverage entirely

2.                  Select UM coverage at $25,000/$50,000 and PD at $10,000 or $60,000 (CSL) .

3.                  Select UM coverage at $25,000/$50,000 or $50,000 (CSL) and reject PD coverage.

4.                  Reject UIM coverage.

5.     Select UIM coverage at policy limits

6.                  Select UIM coverage at a limit that is NOT LESS than $50,000 and NOT GREATER than policy limits

IOWA

62590(6/05)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82794)

§         CA 21 12 IA Uninsured and Underinsured Motorists Coverage

§         CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82795)

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $20,000/$40,000 or $40,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM Entirely.

2.  Select UM coverage at policy limits

3.  Select UM coverage at a limit that is NOT LESS than $20,000/$40,000 or $40,000 (CSL) and NOT GREATER than policy limits

4.  Reject UIM Entirely.

5.  Select UIM coverage at $20,000/$40,000 or $40,000 (CSL)

6.  Select UIM coverage at policy limits

7.  Select UIM coverage at a limit that is NOT LESS than $20,000/$40,000 or $40,000 (CSL) and NOT GREATER than policy limits

KANSAS

78659(6/03)

§         CA 21 25 KS Split Uninsured Motorists Coverage Limits

§         CA 21 37 KS Uninsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage at policy limits unless a lower limit is selected.

1.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

2.  Select UM coverage at policy limits

3.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

KENTUCKY

62594(6/03)

§         CA 21 35 KY Split Uninsured Motorists Coverage Limits

§         CA 21 76 KY Uninsured Motorists Coverage

§         CA 21 79 KY Underinsured Motorists Coverage

§         CA 31 14 KY Split Underinsured Motorists Coverage Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $60,000 (CSL) unless coverage is rejected or a higher limit is selected.

UIM coverage is not included in the policy.

1.     Reject UM coverage entirely

2.     Select UM coverage at $25,000/$50,000 or $60,000 (CSL)

3.     Select UM coverage at policy limits

4.     Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $60,000 (CSL) and NOT GREATER than policy limits

5.     Reject UIM coverage entirely

6.     Select UIM coverage at $25,000/$50,000 or $60,000 (CSL)

7.     Select UIM coverage at policy limits

8.     Select UIM coverage at a limit that is NOT LESS than $25,000/$50,000 or $60,000 (CSL) and NOT GREATER than policy limits

LOUISIANA

62596(8/08)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82796)

§         CA 21 48 LA Uninsured Motorists Coverage – Bodily Injury

§         CA 21 81 LA Uninsured Motorists Coverage – Property Damage

§         CA 31 19 LA Economic Loss Uninsured Motorists Coverage – Bodily Injury

§         CA 31 20 LA Economic Loss Split Uninsured Motorists Coverage Limits – Bodily Injury

Obtain a signed Notice at renewal this will permit insertion of the new policy number.  If you use a continuous policy number a new form at renewal is not necessary.

All policies include UMBI coverage at policy limits unless coverage is rejected or a lower limit is selected.

UMPD coverage is not included in the policy, but must be provided in the amount of $25,000 if the Insured (a) requests such coverage and (b) does not carry collision coverage.

1.  Select UMBI coverage at policy limits

2.  Select UMBI coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

3.  Select Economic-Only UMBI coverage at policy limits

4.  Select Economic-Only UMBI coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

5.  Reject UMBI coverage entirely

6.  LDIO Bulletin 08-02

MAINE

63585(6/03)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82797)

§         CA 21 74 ME Uninsured Motorists Coverage

Obtain a signed Notice at  renewal.

All policies include UM coverage at policy limits unless a lower limit is selected.

1.  Select UM coverage at policy limits

2.  Select UM coverage at $50,000/$100,000 or $100,000 (CSL)

3.  Select UM coverage at a limit that is NOT LESS than $50,000/$100,000 or $100,000 (CSL) and NOT GREATER than policy limits

MARYLAND

64135(6/03)

§         CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82798)

§         CA 21 13 MD Uninsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $20,000/$40,000/$15,000 or $55,000 (CSL) unless a higher limit is selected.

UMPD coverage is subject to a $250 deductible.

1.  Select UM coverage at $20,000/$40,000/$15,000 or $55,000 (CSL)

2.  Select UM coverage at policy limits

3.  Select UM coverage at a limit that is NOT LESS than $20,000/$40,000/$15,000 or $55,000 (CSL) and NOT GREATER than policy limits

MASSACHUSETTS

67849 (10/06)

MM 99 28 MA Uninsured Motorists Coverage

MM 99 54 MA Underinsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $20,000/$40,000  unless a higher limit is selected.

1.  Select UM coverage at $20,000/$40,000.

2.  Select UM coverage at a limit that is NOT LESS than $20,000/$40,000 and NOT GREATER than the LESSER OF (i) $35,000 /$80,000 or (ii) policy limits.  

MICHIGAN

N/A

§         Michigan Uninsured Motorist Coverage 90041 (11/05)

Writing UM/UIM in Michigan is optional. Underwriters should consult their Divisional Guidelines.

N/A

UM/UIM coverage is optional.

N/A

MINNESOTA

63586(6/03)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82799)

CA 21 24 MN Uninsured and Underinsured Motorists Coverage
(available on all policies with a written date on or after Sept. 1, 2008)

CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82800)

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless a higher limit is selected.

1.  Select UM  coverage at $25,000/$50,000 or $50,000 (CSL)

2.  Select UM  coverage at policy limits

3.  Select UM  coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

4.   Select UIM coverage at $25,000/$50,000 or $50,000 (CSL)

5.  Select UIM coverage at policy limits

6.  Select  UIM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

MISSISSIPPI

62576(1/06)

80520(1/06)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82818)

CA 21 28 MS Uninsured Motorists Coverage Bodily Injury and Property Damage

CA 21 29 MS Uninsured Motorists Coverage Bodily Injury – Stacked

CA 21 61 MS Split Uninsured Motorists Coverage Limits – Stacked

CA 21 80 MS Uninsured Motorists Coverage Bodily injury and Property Damage – Nonstacked

CA 21 82 MS Uninsured Motorists Coverage Bodily Injury – Nonstacked

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include Stacked UM  coverage in the amount of $25,000/$50,000/$25,000 or $50,000 (CSL) unless coverage is rejected, a higher limit is selected, or  Nonstacked UM coverage is selected.

UMPD coverage is subject to a $200 deductible.

1.  Reject Stacked UM coverage in its entirety

2.  Select Stacked UM coverage at $25,000/$50,000/$25,000 or $50,000 (CSL)

3.  Select Stacked UM coverage at policy limits

4.  Select Stacked UM coverage at a limit that is NOT LESS than $25,000/$50,000/$25,000 or $50,000 (CSL) and NOT GREATER than policy limits

5.  Reject Stacked UMPD coverage and select Stacked UMBI coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

1.  Select Nonstacked UMBI and UMPD coverage at split limits

2.  Reject Nonstacked UMPD coverage and select Nonstacked UMBI coverage at split limits

3.  Select Nonstacked UMBI and UMPD coverage at a combined single limit

MISSOURI

63587(7/09)

CA 21 04 MO Uninsured Motorists Coverage

CA 21 56 MO Split Uninsured Motorists Coverage Limits

UIM COVERAGE IS NOT OFFERED OR PROVIDED

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless a higher limit is selected.

1.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

2.  Select UM coverage at policy limits

3.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

MONTANA

62577(6/03)

CA 31 30 MT Split Underinsured Motorists Coverage Limits

CA 21 52 MT Uninsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

5.  Select stacked UM coverage

6.  Waive stacked UM coverage

NEBRASKA

62578(7/08)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82802)

CA 21 70 NE Uninsured and Underinsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless a higher limit is selected.

1.  Select UM and UIM coverage at $25,000/$50,000 or $50,000 (CSL)

2.  Select UM and UIM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits.

NEVADA

62579(6/03)

CA 21 27 NV Uninsured Motorists Coverage
(available on all policies with a written date on or after June. 1, 2008)

CA 31 01 NV Split Uninsured Motorists Coverage Limits

Obtain a signed  Notice  at renewal.

All policies include UM coverage in the amount of $15,000/$30,000 or $30,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at $15,000/$30,000 or $30,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

NEW HAMPSHIRE

NONE

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82803)

CA 31 26 NH Uninsured Motorists Coverage

N/A

All policies include UM coverage in the amount of policy limits.

All policies include UM coverage in the amount of the policy limits.

NEW JERSEY

63590(6/03)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82804)

CA 21 14 NJ Uninsured and Underinsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $15,000/$30,000/$5,000  or $35,000 (CSL) unless a higher limit is selected.

UMPD coverage is subject to a $500 deductible.

1.  Select UM and UIM coverage at $15,000/$30,000/$5,000 or $35,000 (CSL)

2.  Select UM and UIM coverage at a limit that is NOT LESS than $15,000/$30,000/$5,000 or $35,000 (CSL) and NOT GREATER than the policy limits

NEW MEXICO

62580(6/03)

CA 21 32 NM Split Uninsured Motorists Coverage Limits - Stacked

CA 21 15 NM Uninsured Motorists Coverage – Stacked
CA 31 29 NM Uninsured Motorists Coverage - Nonstacked

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

The Notice must become a part of the policy.

All policies include UM coverage in the amount of $25,000/$50,000/$10,000  or $60,000 (CSL) unless coverage is rejected or a higher limit is selected.

UMPD coverage is subject to a $250 deductible.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000/$10,000 or $60,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$10,000 or $60,000 (CSL) and NOT GREATER than policy limits

NEW YORK

63591(2/04)

CA 31 13 NY Uninsured Motorists Coverage Endorsement

83119 NY Supplementary Uninsured/Underinsured Motorists Endorsement

83120 NY Split Supplementary Uninsured/Underinsured Motorists Limits

Obtain a signed Notice at renewal.

All policies include UM coverage in the amount of $25,000 on account of injury to one person and $50,000 on account of death of one person in any accident AND (subject to the each person limits)  $50,000 on account of injuries to more than one person and  $100,000 on account of deaths of more than one person.

1.  Reject SUM coverage entirely

2.  Select SUM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than THE LESSER OF (i) $250,000/$500,000 or $500,000 (CSL) or (ii) policy limits

NORTH CAROLINA

62581(7/08)

CA 01 26 NC Changes

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82805)  

CA 21 16 NC Uninsured Motorists Coverage  

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include Combined UM/UIM coverage at policy limits unless coverage is rejected or a lower limit is selected. 

1.  Reject Combined UM/UIM coverage and select UM coverage at a limit that is NOT LESS than $30,000/$60,000/$25,000 or $85,000 (CSL) and NOT GREATER than $1,000,000/$1,000,000/$100,000 or $1,000,000 (CSL)

2.  Select Combined UM/UIM  coverage at a limit that is NOT LESS than $30,000/$60,000/$25,000 or $85,000 (CSL) and NOT GREATER than $1,000,000/$1,000,000/$100,000 or $1,000,000 (CSL)

3.  Reject UM and Combined UM/UIM coverage entirely

NORTH DAKOTA

63592(7/09)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82806)

CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82807)

CA 21 83 ND Uninsured Motorists Coverage

CA 21 86 ND Underinsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless a higher limit is selected.

1.     Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

2.     Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than THE LESSER OF (i) $100,000/$300,000 or $300,000 (CSL) or (ii) policy limits

3.     Select UIM coverage at $25,000/$50,000 or $50,000 (CSL)

4.     Select  UIM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than THE LESSER OF (i) $100,000/$300,000 or $300,000 (CSL) or (ii) policy limits

OHIO

N/A

§         Ohio Uninsured Motorist Coverage 90040 (11/05)

Writing UM/UIM in Ohio is optional.
Underwriters should consult their divisional guidelines.

N/A

UM/UIM coverage is optional.

N/A

OKLAHOMA

62583(4/05)

CA 21 18 OK Uninsured Motorists Coverage

CA 21 42 OK Split Uninsured Motorists Coverage Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.     Select UM coverage at policy limits

2.     Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

3.     Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

4.     Reject UM coverage entirely

OREGON

62584(6/03)

CA 21 05 OR Uninsured Motorists Coverage – Bodily Injury

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82808)

CA 21 87 OR Uninsured Motorists Coverage – Property Damage Private Passenger Types

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UMBI coverage at policy limits unless a lower limit is selected.

UMPD coverage is not included in the policy.

UMPD coverage applies only to private passenger motor vehicles and is subject to a $300 deductible for hit-and-run drivers and a $200 deductible for all other losses.

1.     Select UMBI coverage at $25,000/$50,000 or $50,000  (CSL)

2.     Select UMBI coverage at policy limits

3.     Select UMBI coverage at a limit  that is NOT LESS than $25,000/$50,000 or $50,000  (CSL) and NOT GREATER than policy limits

4.     Reject UMPD coverage

5.     Select UMPD coverage at a limit that is NOT LESS than $10,000 and NOT GREATER than policy limits

PENNSYLVANIA

62585(6/03)

62598(6/03)

67314(6/03)

CA 21 06 PA Uninsured Motorists Coverage-Stacked

CA 21 67 PA Split Uninsured Motorists Coverage Limits-Stacked

CA 21 91 PA Underinsured Motorists Coverage-Stacked

CA 21 92 PA Uninsured Motorists Coverage - Nonstacked

CA 21 93 PA Underinsured Motorists Coverage - Nonstacked

CA 21 94 PA Split Underinsured Motorists Coverage Limits-Stacked

CA 21 95 PA Split Uninsured Motorists Coverage Limits - Nonstacked

CA 21 96 PA Split Underinsured Motorists Coverage Limits - Nonstacked

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

If the Insured has rejected any of the following: UM coverage, UIM coverage, stacked UM limits or stacked UIM limits, provide a completed Form No. 80388(6/02) at renewal.  Attach this form to the Policy.

Neither UM  nor UIM coverage is included in the policy.

1.     Reject UIM coverage entirely

2.     Select UIM coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

3.     Reject stacked UIM coverage limits

4.     Reject UM coverage entirely

5.     Select UM coverage at a limit that is NOT LESS than $15,000/$30,000 or $30,000 (CSL) and NOT GREATER than policy limits

6.     Reject stacked UM coverage limits

RHODE ISLAND

62599(6/03)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82809 )

CA 21 43 RI Uninsured Motorists Coverage

Obtain a signed Notice at  renewal.

All policies include UM coverage at policy limits unless a lower limit is selected.

UMPD  coverage is subject to a $200 deductible.

1.     Select UM coverage at $25,000/$50,000/$25,000 or $75,000 (CSL)

2.     Select  UM coverage at policy limits

3.     Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$25,000 or $75,000 (CSL) and NOT GREATER than policy limits

4.     Reject UMPD coverage and select UMBI coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

5.     Reject UMBI coverage and select UMPD coverage at a limit that is NOT LESS than $25,000 and NOT GREATER  than policy limits

SOUTH CAROLINA

62600 (4/07)

CA 21 19 SC Uninsured Motorists Coverage

CA 21 88 SC Underinsured Motorists Coverage

CA 21 89 SC Split Uninsured Motorists Limits

CA 21 90 SC Split Underinsured Motorists Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All  policies include UM coverage in the amount of $25,000/$50,000/$25,000 or $75,000 (CSL) unless a higher limit is selected 

UIM coverage is not included in the policy.

1.   Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$25,000 or $75,000 (CSL) and NOT GREATER than policy limits

2.   Select UIM coverage at a limit that is NOT LESS than $25,000/$50,000/$25,000 or $75,000 (CSL) and NOT GREATER than policy limits

3.   Reject UIM coverage entirely

SOUTH DAKOTA

63593(6/03)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82810)

CA 21 41 SD Uninsured and Underinsured Motorists Coverage

CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82811)  

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage at policy limits.  However, if policy limits are greater than $100,000/$300,000 or $300,000 (CSL), we must offer UM and UIM limits in excess of $100,000/$300,000 or $300,000 (CSL) only if the insured requests higher limits.

1.                  Select UM coverage at policy limits if policy limits are less than or equal to  $100,000/$300,000 or $300,000 (CSL)

2.                  Select UM coverage at $100,000/$300,000 or $300,000 (CSL) if policy limits are greater  than  $100,000/$300,000 or $300,000 (CSL)

3.                  Select UM coverage at policy limits if policy limits are greater than  $100,000/$300,000 or $300,000 (CSL)

4.                  Select UIM coverage at policy limits if policy limits are less than or equal to  $100,000/$300,000 or $300,000 (CSL)

5.                  Select UIM coverage at $100,000/$300,000 or $300,000 (CSL) if policy limits are greater  than  $100,000/$300,000 or $300,000 (CSL)

6.                  Select UIM coverage at policy limits if policy limits are greater than  $100,000/$300,000 or $300,000 (CSL)

TENNESSEE

62601(6/03)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82812)

CA 21 20 TN Uninsured Motorists Coverage

Obtain a signed

Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage at policy limits unless coverage is rejected or a lower limit is selected.

UMPD  coverage is subject to a $200 deductible.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000/$10,000 or $60,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$10,000 or $60,000 (CSL) and NOT GREATER than policy limits

5.  Reject UMPD coverage and select UMBI coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

TEXAS

62602(8/08)

TE 04 09 TX Uninsured/Underinsured Motorist Coverage

Note: The following forms will be available shortly

CA 21 09 TX Uninsured/Underinsured Motorists Coverage

CA 31 25 TX Split Uninsured/Underinsured Motorists Coverage Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM/UIM coverage in the amount of 25,000/$50,000/$25,000 or $75,000 (CSL) unless coverage is rejected or a higher limit is selected.

UMPD  coverage  is subject to a $250 deductible.

1.  Reject UM/UIM coverage entirely

2.  Select UM/UIM coverage at $25,000/$50,000/$25,000 or $75,000 (CSL)

3.  Select UM/UIM coverage at policy limits

4.  Select UM/UIM coverage at a limit that is NOT LESS than $25,000/$50,000/$25,000 or $75,000 (CSL) and NOT GREATER than policy limits

5.  Reject UM/UIMPD coverage and select UM/UIMBI coverage at a limit that is NOT LESS than $25,000/$50,000 and NOT GREATER than  policy limits

UTAH

62603(8/08)

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82813)

CA 21 36 UT Uninsured Motorists Coverage – Property Damage

CA 21 46 UT Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82814)

CA 21 62 UT Uninsured Motorists Coverage

CA 31 06 UT Underinsured Motorists Coverage

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy. However, the insured must be notified annually, prior to renewal, of the different levels of UM and UIM coverage available.

All policies include UMBI/UIMBI coverage at policy limits unless coverage is rejected or a lower limit is selected.

UMPD coverage is not included in the policy and is subject to a $250 deductible.

1.     Reject UMBI coverage entirely

2.     Select UMBI coverage  at $25,000/$65,000 or $80,000 (CSL)

3.     Select UMBI coverage at policy limits

4.     Select UMBI coverage at a limit that is NOT LESS than $25,000/$65,000 or $80,000 (CSL) and NOT GREATER than policy limits

5.     Reject UIMBI coverage entirely

6.     Select UIMBI coverage at $10,000/$20,000 or $20,000 (CSL)

7.     Select UIMBI coverage at policy limits

8.     Select UIMBI coverage at a limit that is NOT LESS than $10,000/$20,000 or $20,000 (CSL) and NOT GREATER than policy limits

9.     Reject UMPD

10.               Select UMPD

VERMONT

63594(6/03)

CA 21 63 VT Uninsured Motorists Coverage

CA 21 65 VT Split Uninsured Motorists Coverage Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include  UMBI coverage in the amount of $50,000/$100,000 or $100,000 (CSL) unless a higher limit is selected.

All policies include UMPD coverage in the amount of $10,000.

UMPD coverage is subject to a $150 deductible.

1.  Select UMBI coverage at $50,000/$100,000 or $100,000 (CSL)

2.  Select UMBI coverage at a limit that is NOT LESS than $50,000/$100,000 or $100,000 (CSL) and NOT GREATER than policy limits

3.  Acknowledge that the policy includes UMPD in the amount of $10,000

VIRGINIA

62604(6/03)

62605(6/03)

CA 21 21 VA Uninsured Motorists Endorsement (Chartis US Form No. 84412)

CA 31 27 VA Split Uninsured Motorists Coverage Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All  policies include UM coverage in the amount of $25,000/$50,000/$20,000 or $70,000 (CSL) unless a higher limit is selected. 

UMPD coverage is subject to a $200 deductible for hit-and-run losses.

1.  Select UM coverage at $25,000/$50,000/$20,000 or $70,000 (CSL)

2.  Select UM coverage at policy limits

3.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000/$20,000 or $70,000 (CSL) and NOT GREATER than policy limits

WASHINGTON

62607(6/03)

CA 21 34 WA Underinsured Motorists Coverage

CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82815)

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All  policies include UIM coverage at policy limits unless coverage is rejected or a lower limit is selected.

UIMPD coverage is subject to a $300 deductible for hit-and-run losses and a $100 deductible for all other losses.

1.  Reject UIM coverage entirely

2.  Select UIM coverage at  $25,000/$50,000/$10,000 or $60,000 (CSL)

3.  Select UIM coverage at policy limits

4.  Select UIM coverage at a limit that is NOT LESS than $25,000/$50,000/$10,000 or $60,000 (CSL) and NOT GREATER than policy limits

5.  Reject UIMPD coverage and select UIMBI coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits

WEST VIRGINIA

78927(6/03)

78928(6/03)

78929(6/03)

78930(6/03)

78931(6/03)

CA 21 22 WV Uninsured and Underinsured Motorists Coverage

CA 31 02 WV Split Uninsured and Underinsured Motorists Coverage Limits

Provide the Notice at renewal so that it is part of and attached to the notice of renewal premium.

All policies include UM coverage in the amount of $20,000/$40,000/$10,000 or $50,000 (CSL) unless a higher limit is selected.

UIM coverage is not included in the policy.

1.  Select UM coverage at a limit that is NOT LESS than $20,000/$40,000/$10,000 or $50,000 (CSL) and NOT GREATER than policy limits

2.  Reject UIM coverage entirely

3.  Select UIM coverage at a limit that is NOT LESS than $20,000/$40,000/$10,000 or $50,000 (CSL) and NOT GREATER than policy limits

WISCONSIN

64134(10/09)

CA 21 03 WI Uninsured Motorists Coverage

CA 21 07 Split Uninsured Motorists Coverage Limits (Chartis US Form No. 82816)

CA 21 45 WI Underinsured Motorists Coverage

CA 21 46 Split Underinsured Motorists Coverage Limits (Chartis US Form No. 82817)

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM and UIM coverage in the amount of $100,000/$300,000 or $300,000 (CSL).

1.  Select UM coverage at $100,000/$300,000 or $300,000 (CSL)

2.  Select UM coverage at policy limits

3.  Select UM coverage at a limit that is NOT LESS than 100,000/$300,000 or $300,000 (CSL) and NOT GREATER than policy limits

4.  Select UIM coverage at $100,000/$300,000 or $300,000 (CSL)

5.  Select UIM coverage at policy limits

6.  Select UIM coverage at a limit that is NOT LESS than $100,000/$300,000 or $300,000 (CSL) and NOT GREATER than policy limits

WYOMING

62611(6/03)

CA 21 23 WY Uninsured Motorists Coverage

CA 21 68 WY Split Uninsured Motorists Coverage Limits

Obtain a signed Notice at renewal if the Insured requests a change from its previous selection or if the renewal policy will be materially different than the expiring policy.

All policies include UM coverage in the amount of $25,000/$50,000 or $50,000 (CSL) unless coverage is rejected or a higher limit is selected.

1.  Reject UM coverage entirely

2.  Select UM coverage at $25,000/$50,000 or $50,000 (CSL)

3.  Select UM coverage at policy limits

4.  Select UM coverage at a limit that is NOT LESS than $25,000/$50,000 or $50,000 (CSL) and NOT GREATER than policy limits