Individual Accident and Sickness Insurance Policies - Revised

# STATE OF CONNECTICUT INSURANCE DEPARTMENT Bulletin HC-25 (rev.) December 15, 2000 TO ALL INSURERS LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE RE: INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE POLICIES The purpose of this revised bulletin is to update the discussion of individual accident and sickness insurance previously found in Bulletins HC-25 and HC-33. # Combination Policies All policies must fall within one of the categories of health insurance listed in §38a-469 of the Connecticut General Statutes. The guidelines discussed in this Bulletin expand the standards for the categories of coverage established in the Individual Accident and Sickness Insurance Minimum Standards, beginning at §38a-505-1 of the Regulations of Connecticut State Agencies. These guidelines may be applied to additional categories if deemed appropriate. The Minimum Standards Regulation covers the following categories: - Basic Hospital Expense Coverage - Basic Medical-Surgical Expense Coverage - Hospital Indemnity Coverage - Major Medical Expense Coverage - Disability Income Protection Coverage - Accident Only Coverage - Specified Accident Coverage - Limited Benefit Health Insurance Coverage - Specified Disease Policies Combinations of two or more categories are permitted, provided the minimum standards are met for each category. Two exceptions to this standard are allowed. The first exception allows certain benefits to be added to a policy that meets the minimum standards for a given category. Such benefits may not be related to that category. Specific disclosure language is required. An example of the above would be a hospital indemnity policy with nursing home benefits. This type of policy must be labeled in accordance with its main category, i.e., hospital indemnity policy, and must bear an overprint in quarter inch type or in contrasting color that states: "THIS POLICY MEETS CONNECTICUT'S MINIMUM STANDARDS FOR (INSERT NAME OF CATEGORY). IT ALSO CONTAINS ADDITIONAL BENEFITS. PLEASE READ THE ATTACHED OUTLINE OF COVERAGE WHICH EXPLAINS THE BENEFITS IN DETAIL." The second exception is for an individual health policy that contains all of the benefits required in the minimum standards of a category but at a level of coverage that is lower than the minimum standard. Such policies must be labeled as Limited Benefit Health Insurance Policies (with no other policy description). The policy must bear an over-print in quarter inch type or in contrasting color that states: "THIS POLICY CONTAINS BENEFITS WHICH DO NOT MEET CONNECTICUT MINIMUM STANDARDS. PLEASE READ THE ATTACHED OUTLINE OF COVERAGE WHICH EXPLAINS THE BENEFITS IN DETAIL." www.state.ct.us/cid/ P. O. Box 816 Hartford, CT 06142-0816 An Equal Opportunity Employer For example, a hospital indemnity policy must offer benefits of $30.00 a day for at least 31 days. If a policy offers only $10.00 a day, it must be categorized as a Limited Benefit Health Policy. # Accident Only Coverage Section 38a-505-9(G) permits policies that offer accident only coverage. These policies must fall into one of the following categories (either singly or in combination): a. Death b. Dismemberment c. Disability d. Hospital and Medical Policies that provide disability benefits are subject to the same conditions enumerated in the regulation for Disability Income Coverage, except that they will not include sickness benefits. Policies that provide hospital and medical benefits will be subject to the same conditions enumerated in the regulation for Basic Hospital and Basic Medical-Surgical Expense Coverage, except that they will not include sickness benefits. Susan F. Cogswell Susan F. Cogswell Insurance Commissioner