(a) A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of such policy of any person covered thereunder as to whether:
(1) He or she is covered for similar benefits by:
- (A) Another:
(i) Hospital, surgical, medical, or major medical expense insurance policy;
(ii) Hospital or medical service subscriber contract; or
- (iii) Medical practice or other prepayment plan; or
- (B) Any other plan or program;
- (2) He or she is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
- (3) Similar benefits are provided for or available to such person, pursuant to or in accordance with the requirements of any state or federal law.
(b) The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured thereunder the following reasons only:
(1) Either the:
- (A) Benefits provided under the sources referred to in subdivision (a)(1) or (2) of this section for such person, or benefits provided or available under the sources referred to in subdivision (a)(3) of this section for such person, together with the benefits provided by the converted policy, would result in over-insurance according to the insurer's standards on file with the Insurance Commissioner; or
- (B) Converted policyholder fails to provide the requested information;
- (2) Fraud or material misrepresentation in applying for any benefits under the converted policy;
(3) Eligibility of the insured person for coverage under:
- (A) Medicare (Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded); or
- (B) Any other state or federal law providing for benefits similar to those provided by the converted policy; or
- (4) Other reasons approved by the commissioner.