Contents, approval and provision of summary of coverage; provision of information about guaranteed availability of certain plans for benefits.
1. An insurer shall provide to each policyholder, or producer of insurance acting on behalf of a policyholder, on a form approved by the Commissioner, a summary of the coverage provided by each policy of group or blanket health insurance offered by the insurer. The summary must disclose any:
(a) Significant exception, reduction or limitation that applies to the policy;
(b) Restriction on payment for care in an emergency, including related definitions of emergency and medical necessity;
(c) Right of the insurer to change the rate of premium and the factors, other than claims experienced, which affect changes in rate;
(d) Provisions relating to renewability;
(e) Provisions relating to preexisting conditions; and
(f) Other information that the Commissioner finds necessary for full and fair disclosure of the provisions of the policy.
2. The language of the disclosure must be easily understood. The disclosure must state that it is only a summary of the policy and that the policy should be read to ascertain the governing contractual provisions.
3. The Commissioner shall not approve a proposed disclosure that does not satisfy the requirements of this section and of applicable regulations.
4. In addition to the disclosure, the insurer shall provide information about guaranteed availability of basic and standard plans for benefits to an eligible person.
5. The insurer shall provide the summary before the policy is issued.
Last modified: February 27, 2006