Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 146.00 - Specified Disease Insurance
Section 146.11 - Prohibition Against Post Claims Underwriting
Current through Register 1531, September 27, 2024
(1) All applications and enrollment forms for individual and group specified disease insurance policies, except those that are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant, including information regarding the health history of the applicant. Carriers are also required to provide, along with these forms, a clear explanation in writing of the applicant's rights as set forth in M.G.L. c.175I.
(2) If an application or enrollment form contains a question that asks whether the applicant has had medication prescribed by a physician, then it must also ask the applicant to list the medication that has been prescribed and the reason that the medication was prescribed.
(3) Except for policies that are guaranteed issue:
"Caution: If your answers on this application are incorrect or untrue, [carrier] has the right to deny benefits or rescind your policy."
"Caution: The issuance of this specified disease [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers were incorrect or untrue as of the date you signed the application, the carrier has the right to deny benefits or rescind your policy subject to the [time limit on certain defenses, incontestable] section of your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the carrier at this address: [insert address]".
(4) A carrier shall deliver a copy of the completed application or enrollment form to the insured no later than at the time of delivery of the policy unless the form was retained by the insured at the time of application.
(5) Every carrier selling or issuing individual or group specified disease insurance policies in Massachusetts shall maintain a record of all individual policy or group certificate rescissions, on a state basis, except those that the insured voluntary effectuated, and shall furnish this information to the commissioner upon request.
