Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-23 - Accident and sickness insurance; deceptive practices; requirements; prohibitions

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Paragraphs (3),
			 (4) and (5) of subsection (b) shall not apply to credit accident and sickness
			 insurance, group accident and sickness insurance, nor to medicare supplement
			 policies as defined in K.A.R. 40-4-35.
(b) Each authorized issuer of accident and
			 sickness insurance contracts and each authorized insurance agent who solicits,
			 negotiates or procures such insurance within this state shall meet the
			 following requirements:
(1) Each agent shall,
			 at the beginning of any solicitation, inform the prospective purchaser that he
			 or she is acting as an insurance agent.
(2) The prospective purchaser shall be
			 informed of the insurer's full name.
(3) The agent or insurer shall provide to the
			 prospective purchaser before or with the delivery of a contract, a dated
			 outline of coverage describing the elements of the contract including:
(A) The name and signature of the insurance
			 agent, or if no agent is involved, the name of the employee of the insurer who
			 assumes responsibility for completing the outline;
(B) the full name of the company writing the
			 accident and sickness insurance;
(C) a statement identifying the applicable
			 category or categories of coverage provided by the policy or contract and any
			 supplemental riders as prescribed in
			 K.S.A.
			 40-2218(a);
(D) a statement disclosing any provision in
			 the policy or any supplemental riders which will reduce the benefits payable
			 while the policy and riders are maintained in force on a premium-paying basis;
(E) the premiums for the accident
			 and sickness insurance policy and a separate listing of the premiums for each
			 optional or supplemental benefit provided by the contract;
(F) a statement disclosing the provisions of
			 the policy and any supplemental riders relating to renewability, cancelability
			 and termination and any modification of benefits, losses covered or premiums
			 because of age or for other reasons. The description shall be written in a
			 manner which will not minimize or render obscure the qualifying conditions;
(G) a statement disclosing those
			 exceptions, reductions and limitations affecting the basic provisions of the
			 policy and any supplemental riders;
(H) a statement disclosing the existence of
			 any waiting, elimination, probationary or similar time period between the
			 effective date of the policy and effective date of coverage under the policy
			 and any supplemental riders, or a period of time between the date that loss
			 occurs and the date the benefits begin to accrue for the loss;
(I) a statement disclosing the extent to
			 which any loss is not covered under the policy and any supplemental riders, if
			 the cause of the loss is traceable to a condition existing before the effective
			 date of the policy or rider;
(J) a
			 statement disclosing all the principal benefits provided by the policy or
			 contract and any supplemental riders;
(K) a statement that the outline of coverage
			 is a summary of the policy or contract and any supplemental riders issued or
			 applied for and that the policy or contract and any supplemental riders should
			 be consulted to determine governing contractual provisions; and
(L) if the policy or contract and any
			 supplemental riders do not provide the standards for benefits promulgated by
			 the commissioner, as provided in K.A.R. 40-4-24 through 40-4-33, a statement
			 which clearly sets forth the policy restrictions.
(4) The outline of coverage shall accompany
			 the policy. Alternatively, the outline may be delivered to the prospective
			 purchaser at the time application is made, if an acknowledgment of receipt or
			 certificate of delivery of the outline is obtained with the application. If an
			 outline of coverage was delivered at the time of application, and the policy or
			 contract is issued on a basis which would require revision of the outline, a
			 substitute outline of coverage properly describing the policy or contract and
			 any supplemental riders shall accompany the policy or contract and any
			 supplemental riders when it is delivered. The substitute outline shall state
			 clearly that the policy or contract and any supplemental riders are not the
			 same as that for which application was made.
(5) The outline of coverage may consist of a
			 separate written presentation or the outline may be included in the
			 solicitation material advertising the policy. All information required to be
			 disclosed shall be set out prominently in an uninterrupted sequence in one
			 location in the separate, written presentation or advertising material.
			 Additional material, other than that required, shall not be inserted between
			 each required disclosure item. The style, arrangement and overall appearance of
			 the outline of coverage shall not give any undue prominence to any portion of
			 the text. Each printed portion of the text of the outline of coverage shall be
			 plainly printed in lightfaced type of a style in general use. The size of the
			 type shall be uniform and shall not be less than tenpoint with a lowercase,
			 unspaced alphabet length not less than 120 point.