Regulations concerning disclosures by carrier to small employer; copy of disclosure to be made available to small employer.
1. The Commissioner shall adopt regulations which require a carrier to file with the Commissioner, for his approval, a disclosure offered by the carrier to a small employer. The disclosure must include:
(a) Any significant exception, reduction or limitation that applies to the policy;
(b) Any restrictions on payments for emergency care, including, without limitation, related definitions of an emergency and medical necessity;
(c) The provision of the health benefit plan concerning the carrier’s right to change premium rates and the characteristics, other than claim experience, that affect changes in premium rates;
(d) The provisions relating to renewability of policies and contracts;
(e) The provisions relating to any preexisting condition; and
(f) Any other information that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of a policy or contract of insurance issued pursuant to this chapter.
2. The disclosure must be written in language which is easily understood and must include a statement that the disclosure is a summary of the policy only, and that the policy itself should be read to determine the governing contractual provisions.
3. The Commissioner shall not approve any proposed disclosure submitted to him pursuant to this section which does not comply with the requirements of this section and the applicable regulations.
4. The carrier shall make available to a small employer or a producer acting on behalf of a small employer, upon request, a copy of the disclosure approved by the Commissioner pursuant to this section for policies of health insurance for which that employer may be eligible.
Last modified: February 27, 2006