(1)
Policies of individual insurance and certificates and policies of group
insurance shall use the following prescribed statement only, except that
appropriate
policy and certificate identification may be included:
COMPANY NAME
SPECIFIED DISEASE COVERAGE ONLY
REQUIRED DISCLOSURE STATEMENT
This policy or certificate is (an individual policy of
insurance) (a group policy or certificate). This policy or certificate provides
specified disease coverage ONLY. This policy orcertificatedoes NOT provide
basic hospital, basic medical or major medical insurance. It is a supplement to
your health benefit plan and cannot replace your health benefit plan.
(Accurately list benefits, exclusions, reductions and
limitations of the policy or certificate in a manner which does not encourage
misrepresentation of the actual coverage provided.)
This disclosure statement is a very brief summary of your
policy or certificate.
The policy or certificate itself sets forth the rights and
obligations of both you and the insurance company. It is therefore imperative
that you READ YOUR POLICY OR CERTIFICATE carefully.
The expected benefit ratio for this policy or certificate is
___%. This ratio is the portion of future premiums which the company expects to
return as benefits, when averaged over all people with this policy or
certificate.
(2)
Required Disclosure for Medicare-EligibleApplicants.
Carriers shall provide the Guide to Health Insurance for People with Medicare
and disclosure notice as required by
211 CMR
42.09(4).
