Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.08 - INDIVIDUAL AND GROUP SUPPLEMENTARY DISABILITY INSURANCE MINIMUM STANDARDS RULE › Section 18.04.08.101 - DISCLOSURE PROVISIONS

Current through August 31, 2023
01.
General
			 Rules for Disclosure Provisions
. (3-31-22)
a. All applications for coverages specified
			 in Sections 035 through
			 040 will contain a prominent
			 statement 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." (3-31-22)
b. Each policy or certificate subject to this
			 chapter will include a renewal, continuation or nonrenewal provision. The
			 language or specification of the provision needs to be consistent with the type
			 of contract to be issued. The provision will be appropriately captioned, will
			 appear on the first page of the policy or certificate, and will 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.
			 (3-31-22)
c. 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 will necessitate signed acceptance by the policyholder. After date of
			 policy issue, any rider or endorsement that increases benefits or coverage with
			 a commensurable increase in premium during the policy term is to be agreed to
			 in writing signed by the policyholder, except if the increased benefits or
			 coverage is prescribed by law. The signature requirements in this paragraph
			 apply to group supplemental health insurance certificates only where the
			 certificate holder also pays the insurance premium. (3-31-22)
d. Where a separate additional premium is
			 charged for benefits provided in connection with riders or endorsements, the
			 premium charge will be set forth in the policy or certificate.
			 (3-31-22)
e. 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 will include a definition of the terms and an explanation of the
			 terms in its accompanying outline of coverage. (3-31-22)
f. If a policy or certificate contains any
			 limitations with respect to preexisting conditions, the limitations will appear
			 as a separate paragraph of the policy or certificate and be labeled as
			 "Preexisting Condition Limitations." (3-31-22)
g. All policies and certificates, will have a
			 notice prominently printed on the first page of the policy or certificate
			 stating in substance that the policyholder or certificate holder will have the
			 right to return the policy or certificate within ten (10) days of its delivery
			 and to have the premium refunded if, after examination of the policy or
			 certificate, the policyholder or certificate holder is not satisfied for any
			 reason. (3-31-22)
h. 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
			 will be prominently set forth in the outline of coverage. (3-31-22)
i. If a policy or certificate contains a
			 conversion privilege, it will comply, in substance, with the following:
			 (3-31-22)
i. The caption of the provision will
			 be "Conversion Privilege" or words of similar import. (3-31-22)
ii. The provision will 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; and (3-31-22)
iii. The provision will specify the benefits
			 to be provided on conversion or may state that the converted coverage will be
			 as provided on a policy form then being used by the insurer for that purpose.
			 (3-31-22)