R590-277-5. General Requirements

(1) A contract may not include a definition regarding a matter defined in Section R590-277-3 unless the definition complies with that section. (2) Except for an employer-sponsored health benefit plan, a contract: (a) may not provide for termination of coverage of the spouse or a dependent solely because of the occurrence of an event specified for termination of coverage of the contract holder, other than for nonpayment of premium; and (b) shall provide that in the event of the contract holder's death, the spouse shall become the contract holder. (3) A contract providing coverage for the recipient in a transplant operation shall also provide reimbursement of medically necessary transplant expenses of a live donor. (4) A premium change notice shall be given no less than 45 days before the renewal date. (5)(a) Except under Subsection (5)(b), a completed application: (i) is made part of the contract; and (ii) shall be provided to the applicant before, or at delivery, of the contract. (b) Subsection (5)(a) does not apply to: (i) an employer-sponsored health benefit plan; or (ii) an individual if the application was submitted through the health insurance exchange. (6) A managed care organization offering an individual health benefit plan shall issue with an individual policy: (a)(i) an outline of coverage; or (ii) a benefit summary; and (b) a summary of benefits and coverage.