Current through Register 1531, September 27, 2024
All individualand group policies ofspecified disease insurance
must adequately disclose all policy provisions, including but not limited to
the following provisions;
(1) The
first page of the policy must include the following:
(a) The following statement in 14-point
boldface type: "Notice to buyer: This insurance provides a limited benefit in
the event you are diagnosed with [the specified disease or diseases]. This
policy is a supplement and not a substitute for a health benefit plan. You must
have a health benefit plan in order to purchase this insurance.
(b) A section in boldface type that lists all
pre-existing condition exclusions or limitations or clearly refers to the
separate or stand-alone section within the policy that lists all pre-existing
condition exclusions or limitations.
(c) A section that clearly identifies whether
the policyis noncancelable or guaranteed renewable, and whether it is being
issued on other than an individual basis (policies providing conversion
privileges must specify the benefits to be provided or must state that the
converted coverage shall be on the policy form then being issued by the carrier
for this purpose).
(2)
Policy Language.
(a)
All terms used in the policy must be fully explained so that the insured
understands their relationship to the benefits. No misleading policy names may
be used. The policy, riders and all amendments, as well as application, outline
of coverage and other requires disclosure materials distributed to any
potential applicant must be presented in and mustsatisfythe readability
standards of M.G.L. c. 175, § 2B.
(b) Riders or endorsements that provide a
benefit for which a specific premium is charged must show the premium on the
application, rider, or elsewhere in the policy. Any rider that reduces benefits
requires a signed acceptance by the certificateholder.
(3)
Disclosure Form.
No specified disease insurance policy may be delivered or issued for delivery
in Massachusetts unless the applicant receives a disclosure as set forth in
211 CMR
146.100, if communications occur with
potential applicants prior to meeting with a company's agent. In the case of
face-to-face meetings between an agent and potential insured, the carrier or
its agent must deliver the disclosure prior to the presentation of the
application or enrollment form. In the case of direct response sales, or
enrollment by telephone, internet or self-enrollment as part of an employee
benefits package, the carrier must deliver the format the time the application
or enrollment form is sent to the potential insured.
(4)
Outline of
Coverage. No specified disease insurance policy may be delivered
or issued for delivery in Massachusetts unless the applicant receives an
outline of coverage as set forth in
211 CMR
146.101. The carrier or its agent must
deliver the outline of coverage prior to the presentation of the application or
enrollment form. In the case of direct response sales, the carrier must deliver
the outline of coverage at the time that the application or enrollment form is
sent to the potential insured. The carrier must also make an outline of
coverage available at any time at the potential insureds request. The outline
of coverage must be a document separate from the policy.
(5) Application forms shall include questions
designed to elicit the following:
(a) Whether,
as ofthe date of the application, the applicant and all dependents being
considered for the specified disease policy are covered by a Health Plan. If
the applicant does not respond affirmatively to such question, the policy shall
not be issued.
(b) Whether, as of
the date of the application, the applicant and any dependents being considered
for the specified disease policy have in force and/or applications pending for
another specified disease policy or certificate for the same specified disease
with the same or a different insurer, and whether the insurance applied for is
intended to replace any of this coverage, and
(c) The number of specified diseases for
which the applicant and any dependents being considered for the specified
disease policy have coverage in-force as of the date of application and/or the
number of application(s) pending as of the date of application.
