Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 1 - MINIMUM STANDARDS AND BENEFITS FOR ACCIDENT AND HEALTH INSURANCE › Section 365:10-5-6 - Required disclosure provisions

Current through Vol. 41, No. 20,
				  July 1, 2024
(a)
General rules.
(1) Each
				  individual policy of accident and sickness insurance shall include a renewal,
				  continuation, or non-renewal provision. The language or specification 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 terms must be agreed
				  to in writing signed by the insured, except if the increased benefits 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 Condition
				  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 nonrenewable policies and as otherwise provided
				  in this paragraph, 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. If the insurer does not return
				  any premiums or moneys paid therefor within thirty (30) days from the date of
				  cancellation, the insurer shall pay interest on the proceeds which shall be the
				  same rate of interest as the average United States Treasury Bill rate of the
				  preceding calendar year as certified to the State Insurance Commissioner by the
				  State Treasurer on the first regular business day in January of each year, plus
				  two percentage points which shall accrue from the date of cancellation until
				  the premiums or moneys are returned. In such event, the policy shall be deemed
				  to have been cancelled on the date the policy was placed in the United States
				  mails in a properly addressed post paid envelope; or, if not so posted, on the
				  date of delivery of such policy to the insurer. With respect to policies issued
				  pursuant to a direct response solicitation to persons eligible for Medicare the
				  policy 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 thirty (30) days of its delivery and to have
				  the premium refunded if after examination of the policy the policyholder is not
				  satisfied for any reason. If the insurer does not return any premiums or moneys
				  paid therefor within thirty (30) days from the date of cancellation, the
				  insurer shall pay interest on the proceeds which shall be the same rate of
				  interest as the average United States Treasury Bill rate of the preceding
				  calendar year as certified to the State Insurance Commissioner by the State
				  Treasurer on the first regular business day in January of each year, plus two
				  percentage points which shall accrue from the date of cancellation until the
				  premiums or moneys are returned. In such event, the policy shall be deemed to
				  have been cancelled on the date the policy was placed in the United States
				  mails in a properly addressed post paid envelope; or, if not so posted, on the
				  date of delivery of such policy to the insurer.
(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.
(10) Insurers issuing policies which provide
				  hospital or medical expense coverage on an expense incurred or indemnity basis
				  other than incidentally, to a person's eligible for Medicare by reason of age,
				  shall provide to the policyholder, a Medicare supplement buyer's guide in a
				  form prescribed by the Commissioner. Delivery of the buyer's guide shall be
				  made whether or not the policy qualified as a "Medicare Supplement Coverage" in
				  accordance with this Chapter. Except in the case of direct response insurers,
				  delivery of the buyer's guide shall be made at the time of application and
				  acknowledgment of receipt of certificate of delivery of the buyer's guide shall
				  be provided to the insurer. Direct response insurers shall deliver the buyer's
				  guide upon request but not later than at the time the policy is
				  delivered.
(11) Outlines of
				  coverage delivered in connection with policies defined as Hospital Confinement
				  Indemnity in 365:10-5-6(i), Specified Disease in 365:10-5-6(i), or Limited
				  Benefit Health Insurance Coverage in 365:10-5-6(k) to persons eligible for
				  Medicare by reason of age shall contain in addition to the requirements of
				  365:10-5-6(f), (j) and (k), the following language which shall be printed on or
				  attached to the first page of the outline coverage: This policy IS NOT A
				  MEDICARE SUPPLEMENT policy. If you are eligible for Medicare review the
				  Medicare Supplement Buyer's Guide available from the company.