(a)
- (1) Each policy shall include a renewal, continuation, or nonrenewal provision.
- (2) The language or specification of such provision must be consistent with the type of contract to be issued.
(3) Such provision shall be appropriately captioned and clearly state the:
- (A) Duration, where limited, of renewability; and
- (B) Duration of the term of coverage for which the policy is issued and for which it may be renewed.
(b)
- (1) Except for riders or endorsements by which the insurer effectuates a request made in writing by the policyholder or exercises a specifically reserved right under the policy, all riders or endorsements added to a policy after the date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the policyholder.
- (2) After date of policy issue, any rider or endorsement that increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing signed by the insured, except if the increased benefits or coverage is required by law.
- (c) Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, such premium charge shall be set forth in the policy.
- (d) A policy that provides for the payment of benefits based on standards described as "usual and customary", "reasonable and customary", or words of similar import shall include a definition of such terms and an explanation of such terms in its accompanying outline of coverage.
- (e) If a policy contains any limitations with respect to preexisting conditions, such limitations must appear as a separate paragraph of the policy and be labeled as "Preexisting Condition Limitations".
- (f) All accident-only polices, specified disease policies, and specified accident policies shall contain on the first page of the policy or attached thereto in either contrasting color or in boldface type at least equal to the size of type used for policy captions a prominent statement as follows: “This is an (include appropriate policy title) only policy and it does not pay benefits for loss from any other cause.”
(g)
- (1) All policies, except single premium nonrenewable policies and as otherwise provided in this subsection, shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the policyholder shall have the right to return the policy within ten (10) days of its delivery, unless the policy provides for a greater period, and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason.
- (2) With respect to policies issued pursuant to a direct-response solicitation to persons eligible for Medicare by reason of age, the policy shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the policyholder shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason.
- (h) If age is to be used as a determining factor for reducing the maximum aggregate benefits made available in the policy as originally issued, such fact must be prominently set forth in the outline of coverage.
(i) If a policy contains a conversion privilege, it shall comply in substance with the following:
- (1) The caption of the provision shall be "Conversion Privilege" or words of similar import;
(2) The provision shall indicate the:
- (A) Persons eligible for conversion;
- (B) Circumstances applicable to the conversion privilege, including any limitations on the conversion; and
- (C) Person by whom the conversion privilege may be exercised; and
- (3) The provision shall specify the benefits to be provided on conversion or may state that the converted coverage will be as provided on a policy form then being used by the insurer for that purpose.
(j)
- (1) Insurers issuing policies that provide hospital or medical expense coverage on an expense-incurred or indemnity basis other than incidentally to a person or persons eligible for Medicare by reason of age shall provide to the policyholder a Medicare supplement buyer's guide as described in Minimum Standards for Medicare Supplement Policies, 23 CAR pt. 89.
- (2) Delivery of the buyer's guide shall be made whether or not such individual policy qualifies as a Medicare supplement policy as defined in Minimum Standards for Medicare Supplement Policies.
- (3) Except in the case of direct-response insurers, delivery of the buyer's guide shall be made at the time of application, and acknowledgment of receipt of certification of delivery of the buyer's guide shall be provided to the insurer.
(4) Direct-response insurers shall deliver the buyer's guide:
- (A) Not later than the time the policy is delivered; or
- (B) Sooner upon request.
(5) The phrase "other than incidentally" is intended to exempt policies such as those:
- (A) That provide accidental death benefits for travel or other accidents; and
- (B) Where the medical expense or indemnity, if any, only accompanies such other benefits.
- (k) Outlines of coverage delivered in connection with policies defined in this part as "hospital confinement indemnity", "specified disease", "nursing home confinement indemnity coverage", "intensive care unit indemnity coverage", or "limited benefit health insurance coverage" to persons eligible for Medicare by reason of age shall contain, in addition to the requirements of 23 CAR § 86-304, 23 CAR § 86-307, and Minimum Standards for Medicare Supplement Policies, the following language, which shall be printed on or attached to the first page of the outline of coverage: “This policy IS NOT A MEDICARE SUPPLEMENT POLICY.”
- (l) All specified disease and cancer policies shall contain on the first page of the policy or attached thereto in either contrasting color or in boldface type at least equal to the size of type for policy captions a prominent statement as follows: “CAUTION: This is a limited policy. Read it carefully with the outline of coverage.”