Summary of coverage: Contents of disclosure; approval by Commissioner; copy to be made available to employer or producer acting on behalf of employer.
1. The Commissioner shall adopt regulations which require an insurer to file with the Commissioner, for his approval, a disclosure summarizing the coverage provided by each policy of group health insurance offered by the insurer. 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 related definitions of an emergency and medical necessity;
(c) Any provisions concerning the insurer’s right to change premium rates and the characteristics, other than claim experience, that affect changes in premium rates;
(d) Any provisions relating to renewability;
(e) Any provisions relating to preexisting conditions; and
(f) Any other information,
Ê that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of the policy.
2. The disclosure must be written in language which is easily understood and include a statement that the disclosure is a summary of the policy only, and that the policy 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 insurer shall make available to an employer or a producer acting on behalf of an employer upon request a copy of the disclosure approved by the Commissioner pursuant to this section for each policy of health insurance coverage for which that employer may be eligible.
Last modified: February 27, 2006