19 MAC Pt. 3, R. 7.01
Under the provisions of Title 83, Chapter 9, Mississippi Code of 1972, Annotated, it is
Cite as 19 Miss. Admin. Code Pt. 3, R. 7.01
Under the provisions of Title 83, Chapter 9, Mississippi Code of 1972, Annotated, it is
hereby ordered and directed that on or after the effective date of this regulation, any insurer or
nonprofit health service plan providing health and accident insurance or service contracts may
file for approval policy forms or contracts which coordinate or integrate accident and health
benefits with “other health plans” through the use of a coordination of benefits provision, a
variable deductible, or similar provision.
It is not the purpose of this regulation to mandate or require coordination or integration of
accident and health benefits with “other health plans”. A policy containing such provisions,
however, must be consistent with the guidelines herein established.
“Other health plans” shall include any plan which provides insurance, reimbursement, or
service benefits for hospital, surgical, or medical expenses; this shall include coverage under
group or individual insurance policies, nonprofit health service plans, health maintenance
organization subscriber contracts, self-insured group plans, worker’s compensation coverages,
automobile or homeowners medical pay plans, and Medicare as permitted by federal law. It
shall not include:
A. Medicaid; or
B. Hospital daily indemnity plans; or
C. Specified diseases only policies; or
D. Limited occurrence policies which provide only for intensive care or coronary care at a
hospital, first aid outpatient medical expenses resulting from accidents, or specified
accidents such as travel accidents.
Any insurer or nonprofit health service plan issuing a policy or contract which coordinate or
integrates benefits with “other health plans” must disclose this provision in its
point of sale advertising materials. The definition of what constitutes “other health plans’ must
be clearly stated and set forth in the subject policy or contract.
This regulation shall supersede and fully replace any prior regulation concerning the
prohibitions against coordinating or integrating or limiting accident and health insurance
benefits, specifically including LA & H Regulation No. 84-102, dated September 13, 1984.
This regulation shall become effective thirty (30) days after its adoption and filing with the
Mississippi Secretary of State’s Office, as required by law.
Promulgated and filed with the Office of the Secretary of State on October 28, 1988.