23 CAR § 86-402 – Outline of coverage requirements for individual coverages

(a) No policies subject to this part shall be delivered or issued for delivery in this state unless:
1. (1) An appropriate outline of coverage, as prescribed in 23 CAR §§ 86-403 – 86-410, is completed as to policy or contract;
2. (2) The outline is either delivered with the policy or delivered to the applicant at the time the application is made; and
3. (3) Acknowledgment of receipt or certification of delivery of such outline of coverage is provided to the insurer.
(b) If an outline of coverage was delivered at the time of application and the policy or contract is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or contract must accompany the policy or contract when it is delivered and contain the following statement, in no less than 10-point type, immediately above the company name: "NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application, and the coverage originally applied for has not been issued."
(c)
1. (1) The appropriate outline of coverage for policies or contracts providing hospital coverage that only meets the standards of 23 CAR § 86-302 shall be the statement contained in 23 CAR § 86-403.
2. (2) The appropriate outline of coverage for policies or contracts providing coverage that meet the standards of:
  1. (A) Both 23 CAR §§ 86-302 and 86-303 shall be the statement contained in 23 CAR § 86-405;
  2. (B) Both 23 CAR §§ 86-302 and 86-305 or 23 CAR §§ 86-303 and 86-305 or 23 CAR §§ 86-302, 86-303, and 86-305 shall be the statement contained in 23 CAR § 86-407;
  3. (C) Either 23 CAR § 86-304, § 86-309, or § 86-310 shall be the statement contained in 23 CAR § 86-406;
  4. (D) 23 CAR § 86-307 or § 86-308 shall be the statement contained in 23 CAR § 86-409;
  5. (E) 23 CAR § 86-306 shall be the statement contained in 23 CAR § 86-408; and
  6. (F) 23 CAR § 86-311 shall be the statement contained in 23 CAR § 86-410.
(d)
1. (1) Appropriate changes in terminology may be made in the outline of coverage in the case of a policy or policies.
2. (2) In any other case where the prescribed outline of coverage is inappropriate for the coverage provided by the policy or contract, an alternate outline of coverage shall be submitted to the Insurance Commissioner for prior approval.