Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-10 - Required disclosure provisions

Current through July 10, 2024
(A)
General
			 Rules.
(1) Each individual policy of
			 accident and sickness insurance or fraternal benefit society certificate shall
			 include a renewal, continuation, or non-renewal provision. The language or
			 specifications of such provision must 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, all riders or
			 endorsements added to a policy after date of issue or at reinstatement or
			 renewal which 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 which increases benefits or coverage with a concomitant
			 increase in premium during the policy term must be agreed to in writing signed
			 by the insured, except if the increase 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.
(4) A policy which 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 such terms and an explanation of such terms in its
			 accompanying outline of coverage.
(5) If a policy contains any limitations with
			 respect to pre-existing conditions, such limitations must appear as a separate
			 paragraph of the policy and be labeled as "Pre-existing Conditions
			 Limitations."
(6) All accident only
			 policies shall contain a prominent statement on the first page of the policy or
			 attached thereto 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) All policies, except
			 single premium non-renewable policies, shall have a notice prominently printed
			 on the first page of the policy or attached thereto stating in substance that
			 the policyholder shall have the right to return the policy within ten (10) days
			 of its delivery and to have the premium refunded if, after examination of the
			 policy, the policyholder is not satisfied for any reason.
(8) If age is to be used as a determining
			 factor for reducing the maximum aggregate benefits made available in the policy
			 as originally issued, such fact must be prominently set forth in the outline of
			 coverage.
(9) 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.