23 CAR § 86-410
23 CAR § 86-410. Limited-benefit health insurance coverage — Outline of coverage
Length: 265 wordsOfficial source
(a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies that do not meet the minimum standards of 23 CAR §§ 86-302 – 86-305 and 86-307 – 86-310.
(b) The items included in the outline of coverage must appear in the sequence prescribed:
(COMPANY NAME)
LIMITED BENEFIT HEALTH COVERAGE
(APPROPRIATE CATEGORY OF 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) Limited Benefit Health Coverage - Policies of this category are
designed to provide, to persons insured, limited or supplemental coverage.
(3) (A brief, specific description of the benefits, including dollar amounts,
contained in this policy.)
(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. Proper disclosure of benefits that vary
according to accidental cause shall be made in accordance with 23 CAR § 86-
301(b)(13).)
(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.)