23 CAR § 86-407. Major medical expense coverage or comprehensive health expense coverage — Outline of coverage

(a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-305. (b) The items included in the outline of coverage must appear in the sequence prescribed: (COMPANY NAME) MAJOR MEDICAL EXPENSE COVERAGE OR [COMPREHENSIVE HEALTH EXPENSE 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) Major Medical Expense Coverage or [Comprehensive Health Expense Coverage] - Policies of this category are designed to provide, to persons insured, coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care, subject to any deductibles, copayment provisions, or other limitations which may be set forth in the policy. Basic hospital or basic medical insurance coverage is not provided. (3) (A brief, specific description of the benefits, including dollar amounts, contained in this policy in the following order: (A) Daily hospital room and board; (B) Miscellaneous hospital services; (C) Surgical services; (D) Anesthesia services; (E) In-hospital medical services; (F) Out-of-hospital care; (G) Maximum dollar amount for covered charges; and (H) Other benefits, if any.) (Note: The above description of benefits shall be stated clearly and concisely and shall include a description of any deductible or copayment provision applicable to the benefits described.) (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 benefits 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.)