23 CAR § 86-404 – Basic medical-surgical expense coverage — Outline of coverage

(a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of 23 CAR § 86-303.
(b) The items included in the outline of coverage must appear in the sequence prescribed: (COMPANY NAME) BASIC MEDICAL-SURGICAL EXPENSE COVERAGE OUTLINE OF COVERAGE (1) Read Your Policy Carefully - This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance contract, and only the actual policy provisions will control your policy. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY. (2) Basic Medical-Surgical Expense Coverage - Policies of this category are designed to provide to persons insured coverage for medical-surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for surgical services, anesthesia services, and in-hospital medical services, subject to any limitations, deductibles, and copayment requirements set forth in the policy. Coverage is not provided for hospital expenses or unlimited medical- surgical expenses. (3) (A brief, specific description of the benefits, including dollar amounts and number of days duration where applicable, contained in this policy, in the following order: (A) Surgical services; (B) Anesthesia services; (C) In-hospital medical services; and (D) Other benefits, if any.) (Note: The above description of benefits shall be stated clearly and concisely and shall include a description of any deductible or copayment provision applicable to the benefits described.) (4) (A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefits described in (3) above.) (5) (A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.)