When a person uses an application form to be completed by the
applicant as an offer to contract for an insured health plan, such application
form shall contain statements disclosing to the applicant the nature of the
policy offered for sale. In complying with 211 CMR 40.13 the following
guidelines as to the contents and applicability of disclosure requirements
shall be used.
If the advertised
or marketed policy contains a provision which allows the carrier to deny claims
for any loss, where the cause of such loss is in some manner traceable to a
condition existing prior to the effective date of the policy, the application
shall state clearly and unambiguously in negative terms the nature and extent
of that exclusion in accordance with guidelines spelled out in
(2) If the application is for a policy whose
benefits are subject to a waiting period either of the deductible kind,
e.g. "fifth day for sickness" or of the one-time exclusionary
kind, "30 day" or "six months for certain conditions," the application must
disclose in negative terms the nature of such exclusion.
(3) The application must disclose for all
health policies whether or not and to what extent benefits are or are not
contingent upon hospital confinement.
(4) The application must disclose the premium
rate for the policy being solicited.
(5) The application must disclose clearly and
unambiguously the terms of renewability and premium guarantee, if
(6) At the completion of the
above required statements of disclosure space shall be made for the applicant's
signature acknowledging understanding of such disclosures.