R527-10-2. Disclosure of Health Insurance Information

Upon written request by the office, the following health insurance information shall be provided:

1. the availability of health and dental insurance to the employee;

2. the health insurance company name, address, and telephone number;

3. the policy number;

4. the names of those covered and their relationship to the employee;

5. the effective dates of coverage;

6. premium and co-payment amounts, deductibles, and exclusions; and

7. claims history for 24 months prior to the date of request by the office.