NDAC 45-06-16-03
Disclosure requirements
Cite as N.D. Admin. Code ยง 45-06-16-03
1.
Disclosure statement. All short-term limited-duration policies as defined under North Dakota
Century Code section 26.1-36-49 must contain the following disclosure on the front cover
page of the policy, the certificate of coverage, and the application in large print:
THIS IS NOT A COMPREHENSIVE MAJOR MEDICAL INSURANCE POLICY.
THIS COVERAGE IS NOT REQUIRED TO COMPLY WITH CERTAIN FEDERAL MARKET
REQUIREMENTS FOR HEALTH INSURANCE, PRINCIPALLY THOSE CONTAINED IN THE
PATIENT PROTECTION AND AFFORDABLE CARE ACT. PLEASE CAREFULLY REVIEW
THE TERMS OF YOUR POLICY TO MAKE SURE YOU ARE AWARE OF ANY EXCLUSIONS
OR LIMITATIONS REGARDING COVERAGE OF PRE-EXISTING CONDITIONS OR HEALTH
BENEFITS (SUCH AS HOPITALIZATION, EMERGENCY SERVICES, MATERNITY CARE,
PREVENTATIVE CARE, PRESCRIPTION DRUGS, HABILITATIVE AND REHABILITATIVE
CARE, AND MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES). YOUR
POLICY MIGHT ALSO HAVE LIFETIME AND/OR ANNUAL DOLLAR LIMITS ON HEALTH
BENEFITS. IF THIS COVERAGE EXPIRES OR YOU LOSE ELIGIBILITY FOR THIS
COVERAGE, YOU MAY HAVE TO WAIT UNTIL AN OPEN ENROLLMENT PERIOD TO
OBTAIN OTHER HEAL TH INSURANCE COVERAGE.
2.
Outline of coverage. The outline of coverage must provide the following information:
a.
Types of benefits provided.
b.
Cost-sharing provisions and maximum limits.
c.
Describe how benefit payments are determined.
d.
Exclusions and limitations.
e.
Renewability provisions.