N.H. Code Admin. R. Ins 1901.07 - Required Disclosure Provisions

State Regulations
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(a) General Rules.

(1) All applications for coverages specified in Ins 1901.06(b), (c), (d), (e), (g), (i), (j), (k) and (l) shall contain a prominent statement by type, stamp or other appropriate means in either contrasting color or in boldface type at least equal to the size type used for the headings or captions of sections of the application and in close conjunction with the applicant's signature block on the application as follows:

"The [policy] [certificate] provides limited benefits. Review your [policy] [certificate] carefully."

(2) All applications for dental plans shall contain a prominent statement by type, stamp or other appropriate means in either contrasting color or in boldface type at least equal to the size type used for the headings or captions of sections of the application and in close conjunction with the applicant's signature block on the application as follows:

"The [policy] [certificate] provides dental benefits only. Review your [policy] [certificate] carefully."

(3) All applications for vision plans shall contain a prominent statement by type, stamp or other appropriate means in either contrasting color or in boldface type at least equal to the size type used for the headings or captions of sections of the application and in close conjunction with the applicant's signature block on the application as follows:

"The [policy] [certificate] provides vision benefits only. Review your [policy] [certificate] carefully."

(4) Each policy of individual accident and health insurance or group supplemental accident and health insurance shall include a renewal, continuation or nonrenewal provision. The language or specification of the provision shall be consistent with the type of contract to be issued. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.

(5) Except for riders or endorsements by which the insurer effectuates a request made in writing by the policyholder or exercises a specifically reserved right under the policy, all riders or endorsements added to a policy after date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the policyholder. After date of policy issue, any rider or endorsement that increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing signed by the policyholder, except if the increased benefits or coverage is required by law. The signature requirements in this paragraph apply to group supplemental health insurance certificates only where the certificateholder also pays the insurance premium.

(6) Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge shall be set forth in the policy or certificate.

(7) A policy or certificate that provides for the payment of benefits based on standards described as "usual and customary," "reasonable and customary," or words of similar import shall include a definition of the terms and an explanation of the terms in its accompanying outline of coverage.

(8) If a policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate and be labeled as "Preexisting Condition Limitations."

(9) All accident-only policies and certificates shall contain a prominent statement on the first page of the policy or certificate, in either contrasting color or in boldface type at least equal to the size of type used for headings or captions of sections in the policy or certificate, a prominent statement as follows:

"Notice to Buyer: This is an accident-only [policy] [certificate] and it does not pay benefits for loss from sickness. Review your [policy] [certificate] carefully."

(10) Accident-only policies and certificates that provide coverage for hospital or medical care shall contain the following statement in addition to the Notice to Buyer in (9) above:

"This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses."

(11) All policies and certificates, except single-premium nonrenewable policies and as otherwise provided in this paragraph, shall have a notice prominently printed on the first page of the policy or certificate or attached to it stating in substance that the policyholder or certificateholder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the policyholder or certificateholder is not satisfied for any reason.

(12) If age is to be used as a determining factor for reducing the maximum aggregate benefits made available in the policy or certificate as originally issued, that fact shall be prominently set forth in the outline of coverage.

(13) If a policy or certificate contains a conversion privilege, it shall comply, in substance, with the following: The caption of the provision shall be "Conversion Privilege" or words of similar import. The provision shall indicate the persons eligible for conversion, the circumstances applicable to the conversion privilege, including any limitations on the conversion, and the person by whom the conversion privilege may be exercised. The provision shall specify the benefits to be provided on conversion or may state that the converted coverage shall be as provided on a policy form then being used by the insurer for that purpose.

(14) Outlines of coverage delivered in connection with policies defined in this part as hospital confinement indemnity, specified disease, or limited benefit health coverages to persons eligible for Medicare by reason of age shall contain, in addition to the requirements of subsections (f) and (j), 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."

a. An insurer shall deliver to persons eligible for Medicare any notice required under Ins 1905.16(d).

(15) Insurers, except direct response insurers, shall give a person applying for cancer insurance the NAIC's "A Shopper's Guide To Cancer Insurance" at the time of application enrollment and shall obtain all recipient's written acknowledgement of the guide's delivery. Direct response insurers shall provide the NAIC's "A Shopper's Guide to Cancer Insurance" upon request but not later than the time that the policy or certificate is delivered.

(16) All specified disease policies and certificates shall contain on the first page or attached to it in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy or certificate, a prominent statement as follows:

"Notice to Buyer: This is a specified disease [policy] [certificate]. This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses. Read your [policy] [certificate] carefully with the outline of coverage and the "Buyer's Guide."

(17) All hospital confinement indemnity policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This is a hospital confinement indemnity [policy] [certificate]. This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses."

(18) All limited benefit policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type use for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This is a limited benefit health [policy] [certificate]. This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses."

(19) All basic hospital expense policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This is a basic hospital expense [policy] [certificate]. This [policy] [certificate] provides limited benefits and should not be considered a substitute for comprehensive health insurance coverage."

(20) All basic medical-surgical expense policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This is a basic medical-surgical expense [policy] [certificate]. This [policy] [certificate] provides limited benefits and should not be considered a substitute for comprehensive health insurance coverage."

(21) All basic hospital/medical-surgical expense policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This is a basic hospital/medical-surgical expense [policy] [certificate]. This [policy] [certificate] provides limited benefits and should not be considered a substitute for comprehensive health insurance coverage."

(22) All individual basic medical expense policies shall display prominently by type, stamp or other appropriate means on the first page of the policy, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy the following:

"Notice to Buyer: This is an individual basic medical expense policy. This policy provides benefits that are not as comprehensive as individual major medical expense coverage and should not be considered a substitute for comprehensive health insurance coverage."

(23) All dental plan policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This [policy] [certificate] provides dental benefits only."

(24) All vision plan policies and certificates shall display prominently by type, stamp or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy] [certificate] the following:

"Notice to Buyer: This [policy] [certificate] provides vision benefits only."

(b) Outline of Coverage Requirements.

(1) An insurer shall deliver an outline of coverage to an applicant or enrollee in the sale of individual accident and health insurance, group supplemental health insurance, dental plans and vision plans as required in Ins 1901.05.

(2) 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 shall 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] [enrollment], and the coverage originally applied for has not been issued."

(3) The appropriate outline of coverage for polices or contracts providing hospital coverage that only meets the standards of Ins 1901.06(b) shall be that statement contained in (c) below. The appropriate outline of coverage for policies providing coverage that meets the standards of both Ins 1901.06(b) and (c) shall be the statement contained in (e) below. The appropriate outline of coverage for policies providing coverage which meets the standards of both Ins 1901.06(b) and (e) or Ins 1901.06(c) and (e) or Ins 1901.06(b), (c) and (e) shall be the statement contained in (g) below.

(4) In any case 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.

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

(c) Basic Hospital Expense Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(b). The items included in the outline of coverage shall appear in the sequence prescribed:

[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!

(1) Basic hospital 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.

(2) 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:

a. Daily hospital room and board;

b. Miscellaneous hospital services;

c. Hospital out-patient services; and

d. Other benefits, if any.

(3) 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 described in (2) above.

(4) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(d) Basic Medical-Surgical Expense Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(c). The items included in the outline of coverage shall appear in the sequence prescribed:

[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

(1) 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 your policy. 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!

(2) 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 fees or unlimited medical-surgical expenses.

(3) 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:

a. Surgical services;

b. Anesthesia services;

c. In-hospital medical services; and

d. Other benefits, if any.

(4) 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 described in (3) above.

(5) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(e) Basic Hospital/Medical-Surgical Expense Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(b) and (c). The items included in the outline of coverage shall appear in the sequence prescribed.

[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

(1) 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.

(2) 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.

(3) 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:

a. Daily hospital room and board;

b. Miscellaneous hospital services;

c. Hospital outpatient services;

d. Surgical services;

e. Anesthesia services;

f. In-hospital medical services; and

g. Other benefits, if any.

(4) 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 described in (3) above.

(5) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to charge premiums.

(f) Hospital Confinement Indemnity Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(e). The items included in the outline of coverage shall appear in the sequence prescribed:

[ 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

(1) Read Your [Policy] [Certificate] Carefully. This outline of coverage provides a very brief description of the important feature 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!

(2) 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 others than the fixed daily indemnity for hospital confinement and any additional benefit described below.

(3) A brief specific description of the benefits in the following order:

a. Daily benefit payable during hospital confinement; and

b. Duration of benefit described in a.

(4) 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, described in (3) above.

(5) Any benefits provided in addition to the daily hospital benefit.

(g) Individual Major Medical Expense Coverage (Outline of Coverage). An outline of coverage in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(f). The items included in the outline of coverage shall appear in the sequence prescribed:

[COMPANY NAME]

INDIVIDUAL MAJOR MEDICAL EXPENSE COVERAGE

OUTLINE OF COVERAGE

(1) Read Your Policy 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 CAREFULLY!

(2) Individual major medical expense coverage is designed to provide, to persons insured, comprehensive coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care, subject to any deductibles, copayment provisions, or other limitations that may be set forth in the policy. Basic hospital or basic medical insurance coverage is not provided.

(3) A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order:

a. Daily hospital room and board;

b. Miscellaneous hospital services;

c. Surgical services;

d. Anesthesia services;

e. In-hospital medical services;

f. Out-of-hospital care;

g. Maximum dollar amount for covered charges; and

h. Other benefits, if any.

(4) 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 described in (3) above.

(5) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(h) Individual Basic Medical Expense Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(g). The items included in the outline of coverage shall appear in the sequence prescribed:

[COMPANY NAME]

INDIVIDUAL BASIC MEDICAL EXPENSE COVERAGE

OUTLINE OF COVERAGE

(2) Individual basic medical expense coverage is designed to provide, to persons insured, limited coverage for major hospital, medical, and surgical expenses incurred as a result of a covered accident or sickness. Coverage is provided for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care, subject to any deductibles, copayment provisions, or other limitations that may be set forth in the policy. Basic hospital or basic medical insurance coverage is not provided.

(3) A brief specific description of the benefits, including dollar amounts, contained in this policy, in the following order:

a. Daily hospital room and board;

b. Miscellaneous hospital services;

c. Surgical services;

d. Anesthesia services;

e. In-hospital medical services;

f. Out-of-hospital care;

g. Maximum dollar amount for covered charges; and

h. Other benefits, if any.

(4) 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 described in (3) above.

(5) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions of any reservation of right to change premiums.

(i) Disability Income Protection Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies meeting the standards of Ins 1901.06(h). The items included in the outline of coverage shall appear in the sequence prescribed:

[COMPANY NAME]

DISABILITY INCOME PROTECTION COVERAGE

OUTLINE OF COVERAGE

(2) Disability income protection 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.

(3) A brief specific description of the benefits contained in this policy.

(4) 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 described in (3) above.

(5) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(j) Accident-Only Coverage (Outline of Coverage). An outline of coverage in the form prescribed below shall be issued in connection with policies meeting the standards of Ins 1901.06(i). The items included in the outline of coverage shall appear in the sequence prescribed:

[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

(1) 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!

(2) 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.

(3) A brief specific description of the benefits contained in this policy.

(4) 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 described in (3) above.

(5) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.

(k) Specified Disease or Specified Accident Coverage (Outline of Coverage). An outline of coverage in the form prescribed below shall be issued in connection with policies or certificates meeting the standards of Ins 1901.06(j) and (k). The coverage shall be identified by the appropriate bracketed title. The items included in the outline of coverage shall appear in the sequence prescribed:

[COMPANY NAME]

[SPECIFIED DISEASE] [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

(1) This 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.

(2) Read Your [policy] [certificate] [Outline of Coverage] 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!

(3) [Specified disease] [Specified accident] coverage is designed to provide, to persons insured, restricted coverage paying benefits ONLY when certain losses occur as a result of [specified diseases] or [specified accidents]. Coverage is not provided for basis hospital, basic medical-surgical, or major medical expenses.

(4) A brief specific description of the benefits, including dollar amounts.

(l) Limited Benefit Health Coverage (Outline of Coverage). An outline of coverage, in the form prescribed below, shall be issued in connection with policies or certificates which do not meet the minimum standards of Ins 1901.06(b), (c), (d), (e), (f), (g), (i) and (k). The items included in the outline of coverage shall appear in the sequence prescribed:

[COMPANY NAME]

LIMITED BENEFIT HEALTH COVERAGE

BENEFITS PROVIDED ARE SUPPLEMENTAL AND

ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES

OUTLINE OF COVERAGE

(1) 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!

(2) Limited benefit health coverage is designed to provide, to persons insured, limited or supplemental coverage.

(3) A brief specific description of the benefits, including dollar amounts.

(4) A description of any provisions that exclude, eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify payment of the benefits described in (3) above.

(5) A description of any provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(m) Dental Plans (Outline of Coverage). An outline of coverage in the form prescribed below shall be used in connection with dental plan policies and certificates. The items included in the outline of coverage shall appear in the sequence prescribed:

(2) A brief specific description of the benefits.

(3) A description of any provisions that exclude, eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify payment of the benefits described in (2) above.

(4) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

(n) Vision Plans (Outline of 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 shall appear in the sequence prescribed:

(2) A brief specific description of the benefits.

(3) A description of any provisions that exclude, eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify payment of the benefits described in (2) above.

(4) A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservations of right to change premiums.

Notes

N.H. Code Admin. R. Ins 1901.07

#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99

New. #8609, eff 4-17-06

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.

No prior version found.