211 CMR 40.13 - Form and Content of Policy Applications

Current through Register 1466, April 1, 2022

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.

(1) 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 211 CMR 40.07(3)(a).
(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 any.
(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.

Notes

211 CMR 40.13
Amended by Mass Register Issue 1342, eff. 6/30/2017.

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