(a) "Specified disease coverage" is a policy
written on a guaranteed renewable basis as prescribed in §
3.3050(b) of
this title (relating to Standards for Renewability Provisions) which meets one
of the following definitions.
(1) A policy
which provides coverages for each person insured under the policy for a
specifically named disease (or diseases) with a deductible amount not to exceed
5.0% of the aggregate maximum benefit and an overall aggregate benefit limit of
no less than $5,000 per person and a benefit period of not less than two years.
If the benefits are subject to be scheduled inside dollar limits, such limits
shall meet the minimum requirements for major medical coverage as prescribed in
§
3.3074 of this title (relating to
Minimum Standards for Major Medical Expense Coverage).
(2) A policy which provides coverage for each
person insured under the policy for a specifically named disease (or diseases)
with no deductible amount and an overall aggregate benefit limit of not less
than $25,000 payable at the rate of not less than $50 a day while confined in a
hospital and a benefit period of not less than 500 days.
(3) In lieu of the minimum benefits specified
in paragraphs (1) and (2) of this subsection, a specified disease policy or
rider, limited to cancer, may provide minimum benefits not less than the
following:
(A) $50 a day for the first 10
days of hospitalization without any elimination period, deductible or
coinsurance factor and $30 a day for each day of continuous hospitalization
thereafter with no limit on the number of days of hospitalization;
(B) x-ray, radium, and cobalt therapy up to a
total of $1,500;
(C) attending
physician(s) charges in hospital (other than the operating surgeon) of $7.50
per day up to a total of $500;
(D)
surgical charges in accordance with the 1969 California Relative Value Schedule
or other acceptable relative value scale of surgical procedure, up to a maximum
of at least $600;
(E) anesthetist
services for an operation in an amount not less than:
(i) 80% of the usual, customary and
reasonable charges; or
(ii) 15% of
the surgical charges benefit;
(F) nursing expenses of $24 per shift for not
less than one shift per day up to $750;
(G) blood transfusions and plasma up to
$500;
(H) prescribed drugs and
medicine up to $250. If an overall aggregate limit on all benefits is used, it
shall be not less than $10,000 per person.
