R590-126-8. Outline of Coverage Requirements

(1) Basic Hospital Expense Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Subsection R590-126-7(1). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE I

(COMPANY NAME)

BASIC HOSPITAL EXPENSE COVERAGE

THIS (POLICY) (CERTIFICATE) PROVIDES LIMITED BENEFITS AND

SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR

COMPREHENSIVE HEALTH INSURANCE COVERAGE

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) 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)(CERTIFICATE) CAREFULLY!

Basic hospital expense coverage is designed to provide, to

persons insured, coverage for hospital expenses incurred as a

result of a covered accident or sickness. Coverage is provided

for daily hospital room and board, miscellaneous hospital

services and hospital outpatient services, subject to any

limitations, deductibles and copayment requirements set forth

in the policy. Coverage is not provided for physicians or

surgeons fees or unlimited hospital expenses.

A brief specific description of the benefits, including dollar

amounts and number of days duration where applicable, contained

in this policy, in the following order: daily hospital room and

board; miscellaneous hospital services; hospital out-patient

services; and other benefits, if any.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservation of right to change premiums.

(2) Basic Medical-Surgical Expense Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Subsection R590-126-7(2). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE II

(COMPANY NAME)

BASIC MEDICAL-SURGICAL EXPENSE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS AND

SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR

COMPREHENSIVE HEALTH INSURANCE COVERAGE

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) 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) (CERTIFICATE) CAREFULLY!

Basic medical-surgical expense coverage is designed to provide,

to persons insured, coverage for medical-surgical expenses

incurred as a result of a covered accident or sickness.

Coverage is provided for surgical services, anesthesia

services, and in-hospital medical services, subject to any

limitations, deductibles and copayment requirements set forth

in the policy. Coverage is not provided for hospital expenses

or unlimited medical-surgical expenses.

A brief specific description of the benefits, including dollar

amounts and number of days duration where applicable, contained

in this policy, in the following order:

surgical services;

anesthesia services;

in-hospital medical services; and

other benefits, if any.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservation of right to change premiums.

(3) Basic Hospital/Medical-Surgical Expense Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Subsections R590-126-7(3). The items included in the outline of coverage must appear in the sequence prescribed.

TABLE III

(COMPANY NAME)

BASIC HOSPITAL/MEDICAL-SURGICAL EXPENSE COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS AND

SHOULD NOT BE CONSIDERED A SUBSTITUTE FOR

COMPREHENSIVE HEALTH INSURANCE COVERAGE

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) 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) (CERTIFICATE) CAREFULLY!

Basic hospital/medical-surgical expense coverage is designed to

provide, to persons insured, coverage for hospital and

medical-surgical expenses incurred as a result of a covered

accident or sickness. Coverage is provided for daily hospital

room and board, miscellaneous hospital services, hospital

outpatient services, surgical services, anesthesia services, and

in-hospital medical services, subject to any limitations,

deductibles and copayment requirements set forth in the policy.

Coverage is not provided for unlimited hospital or medical

surgical expenses.

A brief specific description of the benefits, including dollar

amounts and number of days duration where applicable, contained

in this policy, in the following order:

daily hospital room and board;

miscellaneous hospital services;

hospital outpatient services;

surgical services;

anesthesia services;

in-hospital medical services; and

other benefits, if any.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservation of right to change premiums.

(4) Hospital Confinement Indemnity Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Subsection R590-126-7(4). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE IV

(COMPANY NAME)

HOSPITAL CONFINEMENT INDEMNITY COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT

INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) Carefully-This outline of

coverage provides a very brief description of the important

features of coverage. 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) (CERTIFICATE) CAREFULLY!

Hospital confinement indemnity coverage is designed to provide,

to persons insured, coverage in the form of a fixed daily

benefit during periods of hospitalization resulting from a

covered accident or sickness, subject to any limitations set

forth in the policy. Coverage is not provided for any benefits

other than the fixed daily indemnity for hospital confinement

and any additional benefit described below.

A brief specific description of the benefits in the following

order:

daily benefit payable during hospital confinement; and

duration of benefit.

A description of any policy provisions that exclude, eliminate,

restrict, reduce, limit, delay or in any other manner operate

to qualify payment of the benefit.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservation of right to change premiums.

Any benefits provided in addition to the daily hospital

benefit.

(5) Income Replacement Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Subsection R590-126-7(5). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE V

(COMPANY NAME)

INCOME REPLACEMENT COVERAGE

THIS (POLICY) (CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED

TO COVER ALL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) 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)(CERTIFICATE) CAREFULLY!

Income replacement coverage is designed to provide, to persons

insured, coverage for disabilities resulting from a covered

accident or sickness, subject to any limitations set forth in

the policy. Coverage is not provided for basic hospital, basic

medical-surgical, or major medical expenses.

A brief specific description of the benefits contained in the

policy.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservation of right to change premiums.

(6) Accident Only Coverage.

An outline of coverage in the form prescribed below shall be issued in connection with policies meeting the standards of Subsection R590-126-7(6). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE VI

(COMPANY NAME)

ACCIDENT ONLY COVERAGE

THIS (POLICY)(CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND NOT INTENDED

TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy) (Certificate) Carefully-This outline

of coverage provides a very brief description of the important

features of the coverage. 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)(CERTIFICATE) CAREFULLY!

Accident only coverage is designed to provide, to persons

insured, coverage for certain losses resulting from a covered

accident ONLY, subject to any limitations contained in the

policy. Coverage is not provided for basic hospital, basic

medical-surgical, or major medical expenses.

A brief specific description of the benefits.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservations of right to change premiums.

(7) Specified Accident Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies or certificates meeting the standards of R590-126-7(7). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE VII

(COMPANY NAME)

SPECIFIED ACCIDENT COVERAGE

THIS (POLICY) (CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED

TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy)(Certificate) Carefully-This outline of

coverage provides a very brief description of the important

features of coverage. 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) (CERTIFICATE) CAREFULLY!

Specified accident coverage is designed to provide, to persons

insured, restricted coverage paying benefits ONLY when certain

losses occur as a result of specified accidents. Coverage

is not provided for basic hospital, basic medical-surgical, or

major medical expenses.

A brief specific description of the benefits, including dollar

amounts.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservations of right to change premiums.

(8) Specified Disease Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with policies or certificates meeting the standards of Subsection R590-126-7(8). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE VIII

(COMPANY NAME)

SPECIFIED DISEASE COVERAGE

THIS (POLICY) (CERTIFICATE) PROVIDES LIMITED BENEFITS

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED

TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Specified disease coverage is designed only as a supplement

to a comprehensive health insurance policy and should not

be purchased unless you have this underlying coverage.

Persons covered under Medicaid should not purchase it. Read

the Buyer's Guide to Specified Disease Insurance to review

the possible limits on benefits in this type of coverage.

Read Your (Policy) (Certificate) Carefully--This outline

of coverage provides a very brief description of the

important features of coverage. 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)

(CERTIFICATE) CAREFULLY!

Specified disease coverages designed to provide, to

persons insured, restricted coverage paying benefits

ONLY when certain losses occur as a result of

specified diseases. Coverage is not provided for basic

hospital, basic medical-surgical, or major medical expenses.

A brief specific description of the benefits, including dollar

amounts.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservations of right to change premiums.

(9) Limited Benefit Health Coverage.

Except for dental or vision plans, an outline of coverage, in the form prescribed below, shall be issued in connection with policies or certificates which do not meet the standards of Subsections R590-126-7(1) through (8). The items included in the outline of coverage must appear in the sequence prescribed:

TABLE IX

(COMPANY NAME)

LIMITED BENEFIT HEALTH COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED

TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy) (Certificate) 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) (CERTIFICATE)

CAREFULLY!

Limited benefit health coverage is designed to provide, to

persons insured, limited or supplemental coverage.

A brief specific description of the benefits, including

amounts.

A description of any provisions that exclude, eliminate,

restrict, reduce, limit, delay, or in any other manner

operate to qualify payment of the benefits.

A description of provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservations of right to change premiums.

(10) Dental Coverage.

An outline of coverage, in the form prescribed below, shall be issued in connection with dental plan policies and certificates. The items included in the outline of coverage must appear in the sequence prescribed:

TABLE X

(COMPANY NAME)

DENTAL COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED

TO COVER ALL DENTAL EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy) (Certificate) 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) (CERTIFICATE) CAREFULLY!

A brief specific description of the benefits.

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.

A description of policy provisions respecting renewability

or continuation of coverage, including age restrictions or

any reservations of right to change premiums.

(11) Vision Coverage.

An outline of coverage in the form prescribed below shall be issued in connection with vision plan policies and certificates. The items included in the outline of coverage must appear in the sequence prescribed:

TABLE XI

(COMPANY NAME)

VISION COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED

TO COVER ALL VISION EXPENSES

OUTLINE OF COVERAGE

Read Your (Policy) (Certificate) 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) (CERTIFICATE) CAREFULLY!

A brief specific description of the benefits.

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.

A description of policy provisions respecting renewability or

continuation of coverage, including age restrictions or any

reservations of right to change premiums.

(12) An insurer shall deliver an outline of coverage to an applicant or enrollee prior to or upon the sale of an individual accident and health insurance policy as required in this rule.

(13) If an outline of coverage was delivered at the time of application or enrollment and the policy or certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or certificate must accompany the policy or certificate when it is delivered and contain the following statement in no less than 12 point type, immediately above the company name:

NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon application, and the coverage originally applied for has not been issued.

(14) Outlines of coverage for hospital confinement indemnity, specified disease, or limited benefit policies, which are to be delivered to persons eligible for Medicare by reason of age shall contain the following language, which shall be printed on or attached to the first page of the outline of coverage:

THIS IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for Medicare, review the Guide to Health Insurance for People With Medicare available from the company.

(15) Where the prescribed outline of coverage is inappropriate for the coverage provided by the policy or certificate, an alternate outline of coverage shall be submitted to the commissioner for prior approval.

(16) Advertisements may fulfill the requirements for outlines of coverage if they satisfy the standards specified for outlines of coverage in this rule.