California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.2 - Standard Supplemental Disclosure Forms for Disability Insurance › Section 2540.6 - Standard Supplemental Disclosure Forms for Use with Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Generally.
				  Supplemental disclosure forms for use with certificates shall be in the format
				  set forth below and shall contain no material of an advertising nature except
				  for the logotype of the organization or organizations providing the coverage.
				  Disclosure forms which are physically incorporated into certificates,
				  advertisements or advance announcements of coverage shall not be intermingled
				  with the text of such documents and shall be given prominence relative to that
				  of surrounding text. Disclosure forms which are delivered with certificates
				  shall appear on or be attached to the front cover or inside front pages of the
				  certificates or they may precede the portions of the certificates which set
				  forth the benefits subject to this Article. Disclosure forms for use with
				  "blanket" coverages shall accompany certificates or memorandums of coverage if
				  or when they are delivered to insurers, subscribers or employees.
(b) Drafting Instructions. Supplemental
				  disclosure forms for use with certificates shall be plainly printed in no
				  smaller than 11-point type and shall contain an appropriate caption or heading
				  such as "Outline of Coverage." Such forms shall prominently state the
				  organization or organizations providing the coverage and shall be introduced by
				  a brief statement to the effect that the form is only a summary of the
				  provisions of the certificate which, itself, must be consulted for the
				  important details of the coverage provided. The information required to be
				  disclosed by this section shall be set forth in separate provisions which shall
				  be in the order set forth below. Each provision shall contain a caption or
				  heading which reflects its subject matter.
(1) Categories of Coverage. The first
				  provision shall state the category or categories of coverage provided by the
				  certificate, selected from those defined in Section
				  2540.5, subsections (b) through
				  (k), above.
(2) Benefits. The
				  second provision shall briefly describe the benefits provided by the coverage
				  or shall state the location or locations in the certificate where such benefits
				  are disclosed. If benefits are set forth in the disclosure form, they shall be
				  accompanied by disclosure of any elimination periods, deductible amounts or
				  co-payment requirements applicable to the benefits described.
(3) Exceptions, Reductions and Limitations.
				  The third provision shall briefly describe the exceptions, reductions and
				  limitations to which the coverage is subject or shall state the location or
				  locations in the certificate where such exceptions, reductions or limitations
				  are described. Provisions which may have the effect of reducing benefits
				  otherwise payable because of other coverage are deemed to be "reductions" for
				  the purpose of this provision. Where exceptions, reductions and limitations are
				  described in the certificate in conjunction with the description of benefits,
				  this provision may contain a statement directing the covered person to refer to
				  the benefit descriptions in the certificate.
(4) Continuation of Coverage. The fourth
				  provision shall briefly describe the provisions in the certificate relating to
				  eligibility for coverage and continuation and termination of coverage or shall
				  state the location or locations of such provisions in the
				  certificate.
(5) Premium or
				  Contribution. The fifth provision shall disclose information relative to the
				  premium or contribution paid by the insured, subscriber or employee for
				  disability coverage. Where such premium or contribution is identifiable, its
				  amount in effect at the time the disclosure form is delivered shall be
				  disclosed. Alternatively, this provision may state where such information may
				  be obtained (for example, statements of wages and deductions accompanying
				  employee paychecks or premium notices). Where the premium or contribution for
				  disability coverage is not identifiable because it is combined with the costs
				  of other coverages not subject to this Article, this provision may be limited
				  to a statement to the effect that the cost of the coverage is included within
				  the premium or contribution paid by the insured, subscriber or employee for his
				  benefit plan. This paragraph may be omitted if the coverage is provided without
				  charge to the insured, subscriber or employee.