23 CAR § 86-406
23 CAR § 86-406. Hospital confinement indemnity coverage, nursing home confinement indemnity coverage, or intensive care unit indemnity coverage — Outline of coverage
Length: 336 wordsOfficial source
(a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-304, § 86-309, or § 86-310.
(b) The items included in the outline of coverage must appear in the sequence prescribed:
(COMPANY NAME)
[HOSPITAL CONFINEMENT INDEMNITY],
[NURSING HOME CONFINEMENT INDEMNITY],
OR [INTENSIVE CARE UNIT INDEMNITY] COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully - This outline of coverage provides a very
brief description of the important features of your policy. This is not the
insurance contract, and only the actual policy provisions will control. The policy
itself sets forth in detail the rights and obligations of both you and your
insurance company. It is, therefore, important that you READ YOUR POLICY
CAREFULLY.
(2) Hospital Confinement Indemnity Coverage or Nursing Home
Confinement Indemnity or Intensive Care Unit Indemnity Coverage - Policies of
this category are designed to provide, to persons insured, coverage in the
form of a fixed daily benefit during periods of hospitalization (nursing home
confinement or intensive care) resulting from a covered accident or sickness,
subject to any limitations set forth in the policy. Such policies do not provide
any benefits other than the fixed daily indemnity for hospital confinement
(nursing home confinement or intensive care) and any additional benefit
described below.
(3) (A brief, specific description of the benefits contained in this policy, in
the following order:
(A) Daily benefit payable during (hospital, nursing, or intensive care
unit) confinement; and
(B) Duration of benefit described in (A).)
(Note: The above description of benefits shall be stated clearly and
concisely.)
(4) (A description of any policy provisions that exclude, eliminate, restrict,
reduce, limit, delay, or in any other manner operate to qualify payment of the
benefit described in (3) above.)
(5) (A description of policy provisions respecting renewability or
continuation of coverage, including age restrictions or any reservation of right
to change premiums.)
(6) (Any benefits provided in addition to the daily [hospital, nursing home,
or intensive care unit] benefit.)