North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-15 - Short-Term Care Insurance › Section 45-06-15-14 - Standard format outline of coverage

Current through Supplement No. 393, July, 2024
1.
				The outline of coverage shall be a freestanding document, using no smaller than
				ten-point type.
2. The outline of
				coverage shall contain no material of an advertising nature.
3. Text that is capitalized or underscored in
				the standard format outline of coverage may be emphasized by other means that
				provide prominence equivalent to the capitalization or underscoring.
4. Use of the text and sequence of text of
				the standard format outline of coverage is mandatory, unless otherwise
				specifically indicated.
5. Format
				for outline of coverage:
[COMPANY NAME]
[ADDRESS - CITY AND STATE]
[TELEPHONE NUMBER]
SHORT-TERM CARE INSURANCE
OUTLINE OF COVERAGE
[Policy Number or Group Master Policy and Certificate
				  Number]
[Except for policies or certificates which are guaranteed
				  issue, the following caution statement, or language substantially similar, must
				  appear as follows in the outline of coverage.]
Caution: The issuance of this short-term care insurance
				  [policy] [certificate] is based upon your responses to the questions on your
				  application. A copy of your [application] [enrollment form] [is enclosed] [was
				  retained by you when you applied]. If your answers are incorrect or untrue, the
				  company has the right to deny benefits or rescind your policy. The best time to
				  clear up any questions is now, before a claim arises! If, for any reason, any
				  of your answers are incorrect, contact the company at this address: [insert
				  address]
1. This policy is [an
				individual policy of insurance] ([a group policy] which was issued in the
				[indicate jurisdiction in which group policy was issued]).
2. PURPOSE OF OUTLINE OF COVERAGE. This
				outline of coverage provides a very brief description of the important features
				of the policy. You should compare this outline of coverage to outlines of
				coverage for other policies available to you. This is not an insurance
				contract, but only a summary of coverage. Only the individual or group policy
				contains governing contractual provisions. This means that the policy or group
				policy sets forth in detail the rights and obligations of both you and the
				insurance company. Therefore, if you purchase this coverage, or any other
				coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE)
				CAREFULLY!
3. Terms Under Which the
				Policy OR Certificate May Be Continued in Force or Discontinued.
a. [For short-term care health insurance
				policies or certificates describe the following permissible policy renewability
				provisions: Policies and certificates that are guaranteed renewable shall
				contain the following statement: RENEWABILITY: THIS POLICY [CERTIFICATE] IS
				GUARANTEED RENEWABLE. This means you have the right, subject to the terms of
				your policy [certificate], to continue this policy as long as you pay your
				premiums on time. [Company Name] cannot change any of the terms of your policy
				on its own, except that, in the future, IT MAY INCREASE THE PREMIUM YOU
				PAY]
b. [For group coverage,
				specifically continuation or conversion provisions applicable certificate and
				group policy.]
c. [Describe waiver
				of premium provisions or state that there are not such provisions.]