- (a) Coordination of benefits shall not be permitted.
- (b) Managed care and network requirements shall not be permitted. The policy shall not include a provision requiring pre-certification.
- (c) Expense based benefits and riders shall not be permitted.
- (d) Group coverage shall not include benefits on a per service basis, except for coverage that is provided to associations, but not related to employment, and sold to individuals.
- (e) Policies or certificates providing hospital confinement indemnity or other fixed indemnity coverage shall not contain provisions excluding coverage because of confinement in a hospital operated by the federal government.
- (f) Benefits for “skilled nursing facility”, as defined in Ins 6001.04(b), services shall not be contingent upon a hospital stay.
- (g) A benefits waiting period shall not be permitted.
- (h) Any eligibility waiting period shall not exceed 12 months.
- (i) Coverage shall not be stated on an “up to” basis.
Source. (See Revision Note #2 at chapter heading for Ins 6200) #12659, eff 11-5-18; ss by #13137, eff 11-24-20