Summary of coverage: Contents of disclosure; approval by Commissioner; regulations.
1. The Commissioner shall adopt regulations which require a health maintenance organization to file with the Commissioner, for his approval, a disclosure summarizing the coverage provided by each health care plan offered by the health maintenance organization. The disclosure must include:
(a) Any significant exception, reduction or limitation that applies to the plan; and
(b) Any other information,
Ê that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of the plan.
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 plan only, and that the evidence of coverage 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