Bulletin 2003-11 Disclosure Requirements for Group Accident and Health Insurance Policies Issued...

[LOGO] # South Carolina # Department of Insurance Division of Financial Services 300 Arbor Lake Drive, Suite 1200 Columbia, South Carolina 29223 Mailing Address: P.O. Box 100105, Columbia, S.C. 29202-3105 Telephone: (803) 737-6165 MARK SANFORD Governor ERNST N. CSISZAR Director of Insurance ## BULLETIN NUMBER 2003-11 (Issued Upon October 8, 2003) To: All South Carolina Licensed Accident and Health Insurers and Health Maintenance Organizations From: Ernst N. Csiszar Director of Insurance Subject: Disclosure Requirements for Group Accident and Health Insurance Policies Issued Via Non-Employer Sponsored Associations ### I. PURPOSE The purpose of this bulletin is to provide guidance with respect to the disclosure requirements regarding group accident and health insurance policies issued to non-employer association groups. ### II. DISCLOSURE REQUIREMENTS - A. Each insurer offering coverage under a group accident and health policy which is issued to a non employer association shall be required to make full disclosure to each applicant who is not already a member of the association's health insurance plan. Such disclosure shall be provided at the time the application for coverage is completed. - B. Full disclosure under A. above shall state: - i. The individual must already be or become a member of the association to be eligible for coverage under the group policy; - ii. All costs related to association membership, including but not limited to initial association membership fee and the amount of the annual association dues; - iii. Membership fees and/or dues are in addition to the policy premium; - iv. The association holds the master policy; - v. The premium charged and the terms and conditions of coverage are determined between the association and the insurer; and - vi. The premium, terms and conditions of coverage may be changed by agreement of the association group policyholder and the insurer, without the consent of the individual certificateholder. C. In the event the premium, terms and/or conditions of coverage change, a notice of the changes shall be provided to the certificateholders. The insurer shall notify the certificateholders no later than thirty-one (31) days prior to a change in the premium, terms and/or conditions of the coverage. D. Insurers must adequately disclose any rights of the insured to transfer. III. The rating issues will be addressed in a separate Bulletin to be issued at a later date. If you have any questions, please contact Ann Bishop, Research and Compliance Analyst, at 803-737-6165 or abishop@doi.state.sc.us. 1