1. (1) The purpose of this rule is to:

   1. (a) standardize and simplify the terms and coverage of an accident and health insurance contract;
   2. (b) facilitate public understanding and comparison of coverage;
   3. (c) prohibit use of a provision that is misleading or confusing in connection with the purchase of coverage or the settlement of a claim;
   4. (d) set minimum coverage requirements; and
   5. (e) provide for full disclosure in the sale of insurance.

2. (2) This rule applies to an accident and health insurance contract that is not specifically exempted from this rule, regardless of:

   1. (a) whether the contract is issued to an association, a trust, a discretionary group, or another similar group; or
   2. (b) the situs of delivery of the contract.

3. (3) This rule does not apply to:

   1. (a) an accident and health insurance contract issued to an employee group under Section 31A-22-502;
   2. (b) a contract issued to an employee or member as an addition to a franchise plan in existence on January 1, 2006;
   3. (c) a Medicare supplement contract subject to Section 31A-22-620;
   4. (d) a TRICARE policy, formerly known as a Civilian Health and Medical Program of the Uniformed Services, 10 U.S.C. 55, CHAMPUS settlement insurance policy;
   5. (e) a health benefit plan subject to Title 31A, Chapter 45, Managed Care Organizations;
   6. (f) a short-term limited duration health insurance contract subject to Rule R590-286; or
   7. (g) a long-term care insurance contract subject to Title 31A, Chapter 22, Part 14, Long-Term Care Insurance Standards.

KEY: health insurance

Date of Last Change: May 8, 2026

Notice of Continuation: December 8, 2021

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-2-202; 31A-21-201; 31A-22-605; 31A-22-623; 31A-22-626; 31A-23a-402; 31A-26-301