Current through Register No. 12, March 21, 2024
(a) General Rules.
(1) All applications for coverages specified
in
Ins
1901.06(b), (c), (d), (e), (g), (i), (j), (k) and
(l) shall contain a prominent statement by
type, stamp or other appropriate means in either contrasting color or in
boldface type at least equal to the size type used for the headings or captions
of sections of the application and in close conjunction with the applicant's
signature block on the application as follows:
"The [policy] [certificate] provides limited benefits. Review
your [policy] [certificate] carefully."
(2) All applications for dental plans shall
contain a prominent statement by type, stamp or other appropriate means in
either contrasting color or in boldface type at least equal to the size type
used for the headings or captions of sections of the application and in close
conjunction with the applicant's signature block on the application as follows:
"The [policy] [certificate] provides dental benefits only.
Review your [policy] [certificate] carefully."
(3) All applications for vision plans shall
contain a prominent statement by type, stamp or other appropriate means in
either contrasting color or in boldface type at least equal to the size type
used for the headings or captions of sections of the application and in close
conjunction with the applicant's signature block on the application as follows:
"The [policy] [certificate] provides vision benefits only.
Review your [policy] [certificate] carefully."
(4) Each policy of individual accident and
health insurance or group supplemental accident and health insurance shall
include a renewal, continuation or nonrenewal provision. The language or
specification of the provision shall be consistent with the type of contract to
be issued. The provision shall be appropriately captioned, shall appear on the
first page of the policy, and shall clearly state the duration, where limited,
of renewability and the duration of the term of coverage for which the policy
is issued and for which it may be renewed.
(5) Except for riders or endorsements by
which the insurer effectuates a request made in writing by the policyholder or
exercises a specifically reserved right under the policy, all riders or
endorsements added to a policy after date of issue or at reinstatement or
renewal that reduce or eliminate benefits or coverage in the policy shall
require signed acceptance by the policyholder. After date of policy issue, any
rider or endorsement that increases benefits or coverage with a concomitant
increase in premium during the policy term must be agreed to in writing signed
by the policyholder, except if the increased benefits or coverage is required
by law. The signature requirements in this paragraph apply to group
supplemental health insurance certificates only where the certificateholder
also pays the insurance premium.
(6) Where a separate additional premium is
charged for benefits provided in connection with riders or endorsements, the
premium charge shall be set forth in the policy or certificate.
(7) A policy or certificate that provides for
the payment of benefits based on standards described as "usual and customary,"
"reasonable and customary," or words of similar import shall include a
definition of the terms and an explanation of the terms in its accompanying
outline of coverage.
(8) If a
policy or certificate contains any limitations with respect to preexisting
conditions, the limitations shall appear as a separate paragraph of the policy
or certificate and be labeled as "Preexisting Condition Limitations."
(9) All accident-only policies and
certificates shall contain a prominent statement on the first page of the
policy or certificate, in either contrasting color or in boldface type at least
equal to the size of type used for headings or captions of sections in the
policy or certificate, a prominent statement as follows:
"Notice to Buyer: This is an accident-only [policy]
[certificate] and it does not pay benefits for loss from sickness. Review your
[policy] [certificate] carefully."
(10) Accident-only policies and certificates
that provide coverage for hospital or medical care shall contain the following
statement in addition to the Notice to Buyer in (9) above:
"This [policy] [certificate] provides limited benefits.
Benefits provided are supplemental and are not intended to cover all medical
expenses."
(11) All
policies and certificates, except single-premium nonrenewable policies and as
otherwise provided in this paragraph, shall have a notice prominently printed
on the first page of the policy or certificate or attached to it stating in
substance that the policyholder or certificateholder shall have the right to
return the policy or certificate within 30 days of its delivery and to have the
premium refunded if, after examination of the policy or certificate, the
policyholder or certificateholder is not satisfied for any reason.
(12) If age is to be used as a determining
factor for reducing the maximum aggregate benefits made available in the policy
or certificate as originally issued, that fact shall be prominently set forth
in the outline of coverage.
(13) If
a policy or certificate contains a conversion privilege, it shall comply, in
substance, with the following: The caption of the provision shall be
"Conversion Privilege" or words of similar import. The provision shall indicate
the persons eligible for conversion, the circumstances applicable to the
conversion privilege, including any limitations on the conversion, and the
person by whom the conversion privilege may be exercised. The provision shall
specify the benefits to be provided on conversion or may state that the
converted coverage shall be as provided on a policy form then being used by the
insurer for that purpose.
(14)
Outlines of coverage delivered in connection with policies defined in this part
as hospital confinement indemnity, specified disease, or limited benefit health
coverages to persons eligible for Medicare by reason of age shall contain, in
addition to the requirements of subsections (f) and (j), the following
language, which shall be printed on or attached to the first page of the
outline of coverage:
"This IS NOT A MEDICARE SUPPLEMENT policy. If you are
eligible for Medicare review the Guide to Health Insurance for People With
Medicare available from the company."
a. An insurer shall deliver to persons
eligible for Medicare any notice required under
Ins
1905.16(d).
(15) Insurers, except direct response
insurers, shall give a person applying for cancer insurance the NAIC's "A
Shopper's Guide To Cancer Insurance" at the time of application enrollment and
shall obtain all recipient's written acknowledgement of the guide's delivery.
Direct response insurers shall provide the NAIC's "A Shopper's Guide to Cancer
Insurance" upon request but not later than the time that the policy or
certificate is delivered.
(16) All
specified disease policies and certificates shall contain on the first page or
attached to it in either contrasting color or in boldface type at least equal
to the size type used for headings or captions of sections in the policy or
certificate, a prominent statement as follows:
"Notice to Buyer: This is a specified disease [policy]
[certificate]. This [policy] [certificate] provides limited benefits. Benefits
provided are supplemental and are not intended to cover all medical expenses.
Read your [policy] [certificate] carefully with the outline of coverage and the
"Buyer's Guide."
(17) All
hospital confinement indemnity policies and certificates shall display
prominently by type, stamp or other appropriate means on the first page of the
policy or certificate, or attached to it, in either contrasting color or in
boldface type at least equal to the size type used for headings or captions of
sections in the [policy] [certificate] the following:
"Notice to Buyer: This is a hospital confinement indemnity
[policy] [certificate]. This [policy] [certificate] provides limited benefits.
Benefits provided are supplemental and are not intended to cover all medical
expenses."
(18) All limited
benefit policies and certificates shall display prominently by type, stamp or
other appropriate means on the first page of the policy or certificate, or
attached to it, in either contrasting color or in boldface type at least equal
to the size type use for headings or captions of sections in the [policy]
[certificate] the following:
"Notice to Buyer: This is a limited benefit health [policy]
[certificate]. This [policy] [certificate] provides limited benefits. Benefits
provided are supplemental and are not intended to cover all medical
expenses."
(19) All basic
hospital expense policies and certificates shall display prominently by type,
stamp or other appropriate means on the first page of the policy or
certificate, or attached to it, in either contrasting color or in boldface type
at least equal to the size type used for headings or captions of sections in
the [policy] [certificate] the following:
"Notice to Buyer: This is a basic hospital expense [policy]
[certificate]. This [policy] [certificate] provides limited benefits and should
not be considered a substitute for comprehensive health insurance
coverage."
(20) All basic
medical-surgical expense policies and certificates shall display prominently by
type, stamp or other appropriate means on the first page of the policy or
certificate, or attached to it, in either contrasting color or in boldface type
at least equal to the size type used for headings or captions of sections in
the [policy] [certificate] the following:
"Notice to Buyer: This is a basic medical-surgical expense
[policy] [certificate]. This [policy] [certificate] provides limited benefits
and should not be considered a substitute for comprehensive health insurance
coverage."
(21) All basic
hospital/medical-surgical expense policies and certificates shall display
prominently by type, stamp or other appropriate means on the first page of the
policy or certificate, or attached to it, in either contrasting color or in
boldface type at least equal to the size type used for headings or captions of
sections in the [policy] [certificate] the following:
"Notice to Buyer: This is a basic hospital/medical-surgical
expense [policy] [certificate]. This [policy] [certificate] provides limited
benefits and should not be considered a substitute for comprehensive health
insurance coverage."
(22)
All individual basic medical expense policies shall display prominently by
type, stamp or other appropriate means on the first page of the policy, or
attached to it, in either contrasting color or in boldface type at least equal
to the size type used for headings or captions of sections in the policy the
following:
"Notice to Buyer: This is an individual basic medical expense
policy. This policy provides benefits that are not as comprehensive as
individual major medical expense coverage and should not be considered a
substitute for comprehensive health insurance coverage."
(23) All dental plan policies and
certificates shall display prominently by type, stamp or other appropriate
means on the first page of the policy or certificate, or attached to it, in
either contrasting color or in boldface type at least equal to the size type
used for headings or captions of sections in the [policy] [certificate] the
following:
"Notice to Buyer: This [policy] [certificate] provides dental
benefits only."
(24) All
vision plan policies and certificates shall display prominently by type, stamp
or other appropriate means on the first page of the policy or certificate, or
attached to it, in either contrasting color or in boldface type at least equal
to the size type used for headings or captions of sections in the [policy]
[certificate] the following:
"Notice to Buyer: This [policy] [certificate] provides vision
benefits only."
(b) Outline of Coverage Requirements.
(1) An insurer shall deliver an outline of
coverage to an applicant or enrollee in the sale of individual accident and
health insurance, group supplemental health insurance, dental plans and vision
plans as required in
Ins
1901.05.
(2) If an outline of coverage was delivered
at the time of application or enrollment and the policy or certificate is
issued on a basis which would require revision of the outline, a substitute
outline of coverage properly describing the policy or certificate shall
accompany the policy or certificate when it is delivered and contain the
following statement in no less than 12 point type, immediately above the
company name:
"NOTICE: Read this outline of coverage carefully. It is not
identical to the outline of coverage provided upon [application] [enrollment],
and the coverage originally applied for has not been issued."
(3) The appropriate outline of coverage for
polices or contracts providing hospital coverage that only meets the standards
of
Ins
1901.06(b) shall be that statement
contained in (c) below. The appropriate outline of coverage for policies
providing coverage that meets the standards of both
Ins
1901.06(b) and (c) shall be the
statement contained in (e) below. The appropriate outline of coverage for
policies providing coverage which meets the standards of both
Ins
1901.06(b) and (e) or
Ins
1901.06(c) and (e) or
Ins
1901.06(b), (c) and (e) shall be the
statement contained in (g) below.
(4) In any case where the prescribed outline
of coverage is inappropriate for the coverage provided by the policy or
certificate, an alternate outline of coverage shall be submitted to the
commissioner for prior approval.
(5) Advertisements may fulfill the
requirements for outlines of coverage if they satisfy the standards specified
for outlines of coverage in this part.
(c) Basic Hospital Expense Coverage (Outline
of Coverage). An outline of coverage, in the form prescribed below, shall be
issued in connection with policies meeting the standards of
Ins
1901.06(b). The items included in the
outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
BASIC HOSPITAL EXPENSE COVERAGE
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
AND
SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR
COMPREHENSIVE HEALTH INSURANCE COVERAGE
OUTLINE OF COVERAGE
Read Your [Policy] [Certificate] Carefully - This outline of
coverage provides a very brief description of the important features of your
policy. This is not the insurance contract and only the actual policy
provisions will control. The policy itself sets forth in detail the rights and
obligations of both you and your insurance company. It is, therefore, important
that you READ YOUR [POLICY] [CERTIFICATE] CAREFULLY!
(1) Basic hospital coverage is designed to
provide, to persons insured, coverage for hospital expenses incurred as a
result of a covered accident or sickness. Coverage is provided for daily
hospital room and board, miscellaneous hospital services and hospital
outpatient services, subject to any limitations, deductibles and copayment
requirements set forth in the policy. Coverage is not provided for physicians
or surgeons fees or unlimited hospital expenses.
(2) A brief specific description of the
benefits, including dollar amounts and number of days duration where
applicable, contained in this policy, in the following order:
a. Daily hospital room and board;
b. Miscellaneous hospital services;
c. Hospital out-patient services;
and
d. Other benefits, if
any.
(3) A description of
any policy provisions that exclude, eliminate, restrict, reduce, limit, delay
or in any other manner operate to qualify payment of the benefits described in
(2) above.
(4) A description of
policy provisions respecting renewability or continuation of coverage,
including age restrictions or any reservation of right to change premiums.
(d) Basic
Medical-Surgical Expense Coverage (Outline of Coverage). An outline of
coverage, in the form prescribed below, shall be issued in connection with
policies meeting the standards of
Ins
1901.06(c). The items included in the
outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
BASIC MEDICAL-SURGICAL EXPENSE COVERAGE
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
AND
SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR
COMPREHENSIVE HEALTH INSURANCE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your [Policy] [Certificate]
Carefully - This outline of coverage provides a very brief description of the
important features of your policy. This is not the insurance contract and only
the actual policy provisions will control your policy. The policy itself sets
forth in detail the rights and obligations of both you and your insurance
company. It is, therefore, important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY!
(2) Basic
Medical-Surgical expense coverage is designed to provide, to persons insured,
coverage for medical-surgical expenses incurred as a result of a covered
accident or sickness. Coverage is provided for surgical services, anesthesia
services and in-hospital medical services, subject to any limitations,
deductibles and copayment requirements set forth in the policy. Coverage is not
provided for hospital expenses fees or unlimited medical-surgical
expenses.
(3) A brief specific
description of the benefits, including dollar amounts and number of days
duration where applicable, contained in this policy, in the following order:
a. Surgical services;
b. Anesthesia services;
c. In-hospital medical services;
and
d. Other benefits, if
any.
(4) A description
of any policy provisions that exclude, eliminate, restrict, reduce, limit,
delay or in any other manner operate to qualify payment of the benefits
described in (3) above.
(5) A
description of policy provisions respecting renewability or continuation of
coverage, including age restrictions or any reservation of right to change
premiums.
(e) Basic
Hospital/Medical-Surgical Expense Coverage (Outline of Coverage). An outline of
coverage, in the form prescribed below, shall be issued in connection with
policies meeting the standards of
Ins
1901.06(b) and (c). The items
included in the outline of coverage shall appear in the sequence prescribed.
[COMPANY NAME]
BASIC HOSPITAL/MEDICAL-SURGICAL EXPENSE COVERAGE
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
AND
SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR
COMPREHENSIVE HEALTH INSURANCE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your [Policy] [Certificate]
Carefully. This outline of coverage provides a very brief description of the
important features of your policy. This is not the insurance contract and only
the actual policy provisions will control. The policy itself sets forth in
detail the rights and obligations of both you and your insurance company. It
is, therefore important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY.
(2) Basic
hospital/medical-surgical expense coverage is designed to provide, to persons
insured, coverage for hospital and medical-surgical expenses incurred as a
result of a covered accident or sickness. Coverage is provided for daily
hospital room and board, miscellaneous hospital services, hospital outpatient
services, surgical services, anesthesia services, and in-hospital medical
services, subject to any limitations, deductibles and copayment requirements
set forth in the policy. Coverage is not provided for unlimited hospital or
medical surgical expenses.
(3) A
brief specific description of the benefits, including dollar amounts and number
of days duration where applicable, contained in this policy, in the following
order:
a. Daily hospital room and
board;
b. Miscellaneous hospital
services;
c. Hospital outpatient
services;
d. Surgical
services;
e. Anesthesia
services;
f. In-hospital medical
services; and
g. Other benefits, if
any.
(4) A description of
any policy provisions that exclude, eliminate, restrict, reduce, limit, delay
or in any other manner operate to qualify payment of the benefits described in
(3) above.
(5) A description of
policy provisions respecting renewability or continuation of coverage,
including age restrictions or any reservation of right to charge premiums.
(f) Hospital Confinement
Indemnity Coverage (Outline of Coverage). An outline of coverage, in the form
prescribed below, shall be issued in connection with policies meeting the
standards of
Ins
1901.06(e). The items included in the
outline of coverage shall appear in the sequence prescribed:
[ COMPANY NAME]
HOSPITAL CONFINEMENT INDEMNITY COVERAGE
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED
TO
COVER ALL MEDICAL EXPENSES
OUTLINE OF COVERAGE
(1) Read Your [Policy] [Certificate]
Carefully. This outline of coverage provides a very brief description of the
important feature of coverage. This is not the insurance contract and only the
actual policy provisions will control. The policy itself sets forth in detail
the rights and obligations of both you and your insurance company. It is,
therefore, important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY!
(2) Hospital confinement
indemnity coverage is designed to provide, to persons insured, coverage in the
form of a fixed daily benefit during periods of hospitalization resulting from
a covered accident or sickness, subject to any limitations set forth in the
policy. Coverage is not provided for any benefits others than the fixed daily
indemnity for hospital confinement and any additional benefit described
below.
(3) A brief specific
description of the benefits in the following order:
a. Daily benefit payable during hospital
confinement; and
b. Duration of
benefit described in a.
(4) A description of any policy provisions
that exclude, eliminate, restrict, reduce, limit, delay or in any other manner
operate to qualify payment of the benefit, described in (3) above.
(5) Any benefits provided in addition to the
daily hospital benefit.
(g) Individual Major Medical Expense Coverage
(Outline of Coverage). An outline of coverage in the form prescribed below,
shall be issued in connection with policies meeting the standards of
Ins
1901.06(f). The items included in the
outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
INDIVIDUAL MAJOR MEDICAL EXPENSE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. This outline
of coverage provides a very brief description of the important features of your
policy. This is not the insurance contract and only the actual policy
provisions will control. The policy itself sets forth in detail the rights and
obligations of both you and your insurance company. It is, therefore, important
that you READ YOUR POLICY CAREFULLY!
(2) Individual major medical expense coverage
is designed to provide, to persons insured, comprehensive coverage for major
hospital, medical, and surgical expenses incurred as a result of a covered
accident or sickness. Coverage is provided for daily hospital room and board,
miscellaneous hospital services, surgical services, anesthesia services,
in-hospital medical services, and out-of-hospital care, subject to any
deductibles, copayment provisions, or other limitations that may be set forth
in the policy. Basic hospital or basic medical insurance coverage is not
provided.
(3) A brief specific
description of the benefits, including dollar amounts, contained in this
policy, in the following order:
a. Daily
hospital room and board;
b.
Miscellaneous hospital services;
c.
Surgical services;
d. Anesthesia
services;
e. In-hospital medical
services;
f. Out-of-hospital
care;
g. Maximum dollar amount for
covered charges; and
h. Other
benefits, if any.
(4) A
description of any policy provisions that exclude, eliminate, restrict, reduce,
limit, delay or in any other manner operate to qualify payment of the benefits
described in (3) above.
(5) A
description of policy provisions respecting renewability or continuation of
coverage, including age restrictions or any reservation of right to change
premiums.
(h) Individual
Basic Medical Expense Coverage (Outline of Coverage). An outline of coverage,
in the form prescribed below, shall be issued in connection with policies
meeting the standards of
Ins
1901.06(g). The items included in the
outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
INDIVIDUAL BASIC MEDICAL EXPENSE COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. This outline
of coverage provides a very brief description of the important features of your
policy. This is not the insurance contract and only the actual policy
provisions will control. The policy itself sets forth in detail the rights and
obligations of both you and your insurance company. It is, therefore, important
that you READ YOUR POLICY CAREFULLY!
(2) Individual basic medical expense coverage
is designed to provide, to persons insured, limited coverage for major
hospital, medical, and surgical expenses incurred as a result of a covered
accident or sickness. Coverage is provided for daily hospital room and board,
miscellaneous hospital services, surgical services, anesthesia services,
in-hospital medical services, and out-of-hospital care, subject to any
deductibles, copayment provisions, or other limitations that may be set forth
in the policy. Basic hospital or basic medical insurance coverage is not
provided.
(3) A brief specific
description of the benefits, including dollar amounts, contained in this
policy, in the following order:
a. Daily
hospital room and board;
b.
Miscellaneous hospital services;
c.
Surgical services;
d. Anesthesia
services;
e. In-hospital medical
services;
f. Out-of-hospital
care;
g. Maximum dollar amount for
covered charges; and
h. Other
benefits, if any.
(4) A
description of any policy provisions that exclude, eliminate, restrict, reduce,
limit, delay or in any other manner operate to qualify payment of the benefits
described in (3) above.
(5) A
description of policy provisions respecting renewability or continuation of
coverage, including age restrictions of any reservation of right to change
premiums.
(i) Disability
Income Protection Coverage (Outline of Coverage). An outline of coverage, in
the form prescribed below, shall be issued in connection with policies meeting
the standards of
Ins
1901.06(h). The items included in the
outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
DISABILITY INCOME PROTECTION COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. This outline
of coverage provides a very brief description of the important features of your
policy. This is not the insurance contract and only the actual policy
provisions will control. The policy itself sets forth in detail the rights and
obligations of both you and your insurance company. It is, therefore, important
that you READ YOUR POLICY CAREFULLY!
(2) Disability income protection coverage is
designed to provide, to persons insured, coverage for disabilities resulting
from a covered accident or sickness, subject to any limitations set forth in
the policy. Coverage is not provided for basic hospital, basic
medical-surgical, or major medical expenses.
(3) A brief specific description of the
benefits contained in this policy.
(4) A description of any policy provisions
that exclude, eliminate, restrict, reduce, limit, delay or in any other manner
operate to qualify payment of the benefits described in (3) above.
(5) A description of policy provisions
respecting renewability or continuation of coverage, including age restrictions
or any reservation of right to change premiums.
(j) Accident-Only Coverage (Outline of
Coverage). An outline of coverage in the form prescribed below shall be issued
in connection with policies meeting the standards of
Ins
1901.06(i). The items included in the
outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
ACCIDENT-ONLY COVERAGE
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
BENEFITS PROVIDED ARE SUPPLEMENTAL AND NOT INTENDED TO
COVER ALL MEDICAL EXPENSES
OUTLINE OF COVERAGE
(1) Read Your [Policy] [Certificate]
Carefully. This outline of coverage provides a very brief description of the
important features of the coverage. This is not the insurance contract and only
the actual policy provisions will control. The policy itself sets forth in
detail the rights and obligations of both you and your insurance company. It
is, therefore, important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY!
(2) Accident-only
coverage is designed to provide, to persons insured, coverage for certain
losses resulting from a covered accident ONLY, subject to any limitations
contained in the policy. Coverage is not provided for basic hospital, basic
medical-surgical, or major medical expenses.
(3) A brief specific description of the
benefits contained in this policy.
(4) A description of any policy provisions
that exclude, eliminate, restrict, reduce, limit, delay or in any other manner
operate to qualify payment of the benefits described in (3) above.
(5) A description of policy provisions
respecting renewability or continuation of coverage, including age restrictions
or any reservation of right to change premiums.
(k) Specified Disease or Specified Accident
Coverage (Outline of Coverage). An outline of coverage in the form prescribed
below shall be issued in connection with policies or certificates meeting the
standards of
Ins
1901.06(j) and (k). The coverage
shall be identified by the appropriate bracketed title. The items included in
the outline of coverage shall appear in the sequence prescribed:
[COMPANY NAME]
[SPECIFIED DISEASE] [SPECIFIED ACCIDENT] COVERAGE
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
BENEFITS PROVIDED ARE SUPPLEMENTAL AND
ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES
OUTLINE OF COVERAGE
(1) This coverage is designed only as a
supplement to a comprehensive health insurance policy and should not be
purchased unless you have this underlying coverage. Persons covered under
Medicaid should not purchase it. Read the Buyer's Guide to Specified Disease
Insurance to review the possible limits on benefits in this type of
coverage.
(2) Read Your [policy]
[certificate] [Outline of Coverage] Carefully. This outline of coverage
provides a very brief description of the important features of coverage. This
is not the insurance contract and only the actual policy provisions will
control. The policy itself sets forth in detail the rights and obligations of
both you and your insurance company. It is, therefore, important that you READ
YOUR [POLICY] [CERTIFICATE] CAREFULLY!
(3) [Specified disease] [Specified accident]
coverage is designed to provide, to persons insured, restricted coverage paying
benefits ONLY when certain losses occur as a result of [specified diseases] or
[specified accidents]. Coverage is not provided for basis hospital, basic
medical-surgical, or major medical expenses.
(4) A brief specific description of the
benefits, including dollar amounts.
(l) Limited Benefit Health Coverage (Outline
of Coverage). An outline of coverage, in the form prescribed below, shall be
issued in connection with policies or certificates which do not meet the
minimum standards of
Ins
1901.06(b), (c), (d), (e), (f), (g), (i) and
(k). The items included in the outline of
coverage shall appear in the sequence prescribed:
[COMPANY NAME]
LIMITED BENEFIT HEALTH COVERAGE
BENEFITS PROVIDED ARE SUPPLEMENTAL AND
ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES
OUTLINE OF COVERAGE
(1) Read Your [policy] [certificate]
Carefully. This outline of coverage provides a very brief description of the
important features of coverage. This is not the insurance contract and only the
actual policy provisions will control. The policy itself sets forth in detail
the rights and obligations of both you and your insurance company. It is,
therefore, important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY!
(2) Limited benefit
health coverage is designed to provide, to persons insured, limited or
supplemental coverage.
(3) A brief
specific description of the benefits, including dollar amounts.
(4) A description of any provisions that
exclude, eliminate, restrict, reduce, limit, delay or in any other manner
operate to qualify payment of the benefits described in (3) above.
(5) A description of any provisions
respecting renewability or continuation of coverage, including age restrictions
or any reservations of right to change premiums.
(m) Dental Plans (Outline of Coverage). An
outline of coverage in the form prescribed below shall be used in connection
with dental plan policies and certificates. The items included in the outline
of coverage shall appear in the sequence prescribed:
(1) Read Your [policy] [certificate]
Carefully. This outline of coverage provides a very brief description of the
important features of coverage. This is not the insurance contract and only the
actual policy provisions will control. The policy itself sets forth in detail
the rights and obligations of both you and your insurance company. It is,
therefore, important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY!
(2) A brief specific
description of the benefits.
(3) A
description of any provisions that exclude, eliminate, restrict, reduce, limit,
delay or in any other manner operate to qualify payment of the benefits
described in (2) above.
(4) A
description of policy provisions respecting renewability or continuation of
coverage, including age restrictions or any reservations of right to change
premiums.
(n) Vision
Plans (Outline of Coverage). An outline of coverage in the form prescribed
below shall be issued in connection with vision plan policies and certificates.
The items included in the outline of coverage shall appear in the sequence
prescribed:
(1) Read Your [policy]
[certificate] Carefully. This outline of coverage provides a very brief
description of the important features of coverage. This is not the insurance
contract and only the actual policy provisions will control. The policy itself
sets forth in detail the rights and obligations of both you and your insurance
company. It is, therefore, important that you READ YOUR [POLICY] [CERTIFICATE]
CAREFULLY!
(2) A brief specific
description of the benefits.
(3) A
description of any provisions that exclude, eliminate, restrict, reduce, limit,
delay or in any other manner operate to qualify payment of the benefits
described in (2) above.
(4) A
description of policy provisions respecting renewability or continuation of
coverage, including age restrictions or any reservations of right to change
premiums.
#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5656,
eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99
New. #8609, eff
4-17-06
