23 CAR § 86-410 – Limited-benefit health insurance coverage — Outline of coverage

(a) An outline of coverage, in the form prescribed below, shall be issued in connection with policies that do not meet the minimum standards of 23 CAR §§ 86-302 – 86-305 and 86-307 – 86-310.
(b) The items included in the outline of coverage must appear in the sequence prescribed: (COMPANY NAME) LIMITED BENEFIT HEALTH COVERAGE (APPROPRIATE CATEGORY OF 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. 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) Limited Benefit Health Coverage - Policies of this category are designed to provide, to persons insured, limited or supplemental coverage. (3) (A brief, specific description of the benefits, including dollar amounts, contained in this policy.) (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. Proper disclosure of benefits that vary according to accidental cause shall be made in accordance with 23 CAR § 86- 301(b)(13).) (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.)