Insured’s Right to Examination of Accident and Sickness Coverage

PURPOSE: This rule allows persons ten days following the date of delivery in which to examine accident or health insurance coverage and to return that coverage for a full refund of premium. (1) Applicability. This rule applies to all individual policies subject to sections 376.770–376.795, RSMo and all group insurance certificates defined in section 376.421.2, RSMo which are mass marketed or marketed on an individual basis to citizens of this state. This rule does not apply to single premium short duration trip or travel-type coverage. Mass-marketed health insurance, for purposes of this rule, means the insurance under any individual, franchise, group or blanket policy of accident or health insurance which is offered by means of direct response solicitation through a sponsoring organization or through the mails or other mass communications media and under which the insured person pays all or substantially all of the cost of his/her insurance. (2) The face page of all individual contacts and group certificates which are subject to this rule must contain a conspicuous and clearly captioned paragraph stating in substance that— (A) The person to whom the coverage is issued may return the policy or certificate within at least ten (10) days of delivery for a full refund of all premiums paid; and (B) Any coverage returned for a refund of premium will be null and void from its inception. (3) All these insurance companies shall remit to the person to whom the policy was issued the gross amount of the premium paid in the event the insured elects to return the policy. No insurance company is permitted to deduct or fail to return that portion of the premium retained by the company’s insurance producer or any other expense connected with the premium. (4) No contract or coverage subject to the provisions of this rule shall be approved by the Department of Commerce and Insurance unless it meets the requirements of this rule. AUTHORITY: sections 354.120, 354.380, 374.045 and 376.777, RSMo 2000.* This rule was previously filed as 4 CSR 190-14.010. Original rule filed Dec. 5, 1969, effective Dec. 15, 1969. Amended: Filed Aug. 12, 1974, effective Aug. 22, 1974. Amended: Filed Dec. 1, 1989, effective June 30, 1990. Amended: Filed July 12, 2002, effective Jan. 30, 2003. Non-substantive change filed Sept. 11, 2019, published Oct. 31, 2019. *Original authority: 354.120, RSMo 1973, amended 1983, 1993, 1995; 354.380, RSMo 1983; 374.045, RSMo 1967, amended 1993, 1995; and 376.777, RSMo 1959, amended 1984.