Regulations regarding required disclosures by carrier.
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 voluntary purchasing group. The disclosure must include:
(a) Any significant exception, prior authorization, reduction or limitation that applies to a contract;
(b) Any restrictions on payments for emergency care, including, without limitation, related definitions of an emergency and medical necessity;
(c) Any provision of a contract 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 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 contract.
2. The disclosure must be written in a language which is easily understood and must include a statement that the disclosure is a summary of the contract only, and that the contract 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.
Last modified: February 27, 2006