Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-4 - Required provisions for group health insurance benefits

Current through July 10, 2024
(a) General Rules.
(1) Each group policy or certificate of
			 accident and sickness insurance shall include a renewal, continuation, or
			 non-renewal provision. The language or specifications of such provision shall
			 be consistent with the type of contract to be issued. Such 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.
(2) 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 or certificate, all riders or endorsements added to a policy or
			 certificate after date of issue or at reinstatement or renewal that reduce or
			 eliminate benefits or coverage in the policy or certificate shall require
			 signed acceptance by the policyholder. After the date of policy or certificate
			 issue, any rider or endorsement that increases benefits or coverage with a
			 concomitant increase in premium during the policy term shall be agreed to in
			 writing signed by the policyholder, except if the increase in benefit or
			 coverage is required by law
(3)
			 Where a separate additional premium is charged for benefits provided in
			 connection with riders or endorsements, such premium charge shall be set forth
			 in the policy or certificate.
(4) A
			 policy or certificate that provides for the payment of benefits based on
			 standards described as "usual and customary," "reasonable and customary,"
			 "maximum allowable charge," or words of similar import shall include a
			 definition of such terms and an explanation of such terms.
(5) If a policy or certificate contains any
			 limitations with respect to pre-existing conditions, such limitations shall
			 appear as a separate paragraph of the policy or certificate and be labeled as
			 "Preexisting Conditions Limitations."
(6) All accident only policies shall contain
			 a prominent statement on the first page or an attachment to the policy and
			 certificate in either contrasting color or in boldface type at least equal to
			 the size of type used for policy captions, a prominent statement as follows:
			 "This is an accident only policy and it does not pay benefits for loss from
			 sickness."
(7) If a policy 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 will be as provided on a
			 policy form then being used by the insurer for that purpose.