Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 146.00 - Specified Disease Insurance
Section 146.07 - Minimum Benefit Standards for an Individual Policy Where a Benefit is a Lump-sum Payment for the Diagnosis of a Specified Disease without Further Coverage for Treatment of the Disease

(1) An individual specified disease policy may only be offered with face value amounts in even increments of $1,000 not to exceed $500,000. Carriers may offer a plan with benefits based on a percent of the face amount that results in less than an even $1,000 benefit.

(2) No individual policy or certificate issued pursuant to 211 CMR 146.07 shall contain a waiting period lasting longer than 30 days from the coverage effective date. A provision shall be included in the policy or certificate indicating that for a specified disease diagnosed within the initial 30 days of coverage, the policy is either void from its beginning with a full premium refund to the insured, or the coverage for such diagnosed specified disease is subject to a pre-existing condition limitation not to exceed six month from the coverage effective date. The provision shall also indicate that the insured must elect whether the policy or certificate is to be voided with a full premium refund or coverage is to be delayed.

(3) Indemnity amounts for any one specified disease cannot be required to be paid in more than two equal installments for any reoccurrences or spread of the same specified disease or a new primary occurrence of the same specified disease or the resulting death of the insured due to the same specified disease.

(4) New waiting periods for any one specified disease cannot be instituted for any reoccurrences or spread of the same specified disease or a new primary occurrence of the same specified disease. Waiting periods in addition to those allowed by 211 CMR 146.07(2) are prohibited. However, the insurer can require reasonable and appropriate medical certification that the insured is afflicted with a specified disease covered by the policy.

(5) Benefit amounts payable for any one specified disease can be subject to a maximum policy benefit for all specified diseases covered under the policy.

(6) A benefit shall always be pay able upon initial and medically appropriate diagnosis of the specified disease covered by the policy. There shall be no requirement that the insured survive for any period of time in order for the benefit to be payable.