Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 141 - RULES GOVERNING ACCIDENT AND SICKNESS EXCEPTED BENEFITS POLICIES; SHORT-TERM LIMITED DURATION INSURANCE › Section 14VAC5-141-30 - General policy provisions

Current through Register Vol. 40, No. 24, July 15, 2024
A. Each excepted benefits policy shall
				contain a notice displayed prominently in advertising, application and plan
				materials and on the face of the policy in at least 14-point type the following
				language:
"THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE
				  ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY."
B. A policy that covers specific
				types of benefits or services may not then exclude the same or similar types of
				conditions, illnesses, or events, except for any preexisting condition
				limitations. Benefits shall be reasonable in relation to the premium charged.
				Specific prohibitions may be limited as determined by the commission.
C. Each individual policy issued under this
				chapter may be renewable at the option of the insured, unless otherwise
				specified in this chapter. The renewability provisions shall appear on the
				first page of the policy and be appropriately captioned.
D. If covered, pregnancy, childbirth, or
				miscarriage shall be treated like any other sickness. Complications that arise
				from pregnancy shall be covered.
E.
				In the event an insurer cancels an individual policy in accordance with §
				38.2-3504 of the Code of Virginia, any coverage for pregnancy shall provide for
				an extension of benefits for the duration of the pregnancy if the pregnancy
				commenced while the policy was in force and for which benefits would be payable
				had the policy remained in force.
F. A policy that provides for the payment of
				benefits based on standards described as "usual and customary," "reasonable and
				customary," or similar words shall include an explanation of these
				terms.
G. An individual policy that
				provides for dependent coverage shall provide that in the event of the
				insured's death, a covered spouse of the insured shall become the
				insured.
H. A policy may exclude
				services performed by a member of the covered person's immediate family and
				services for which no charge is normally made in the absence of
				insurance.
I. If an individual
				policy contains a military service exclusion or a provision that suspends
				coverage during military service, the policy shall provide for a refund or
				credit of unearned premium upon receipt of written notice of the military
				service.
J. For any individual
				policy, if additional premium is charged for benefits provided in connection
				with a rider or endorsement, a separate premium amount shall be stated in the
				policy.
K. If a policy contains any
				preexisting condition limitations, these shall appear in a separate paragraph
				in the policy and labeled as "Preexisting Conditions Limitation."
L. If age is used to reduce the maximum
				aggregate benefits available in the policy, this shall be prominently stated in
				the policy.
M. If a policy contains
				a conversion provision, it shall appear in a separate paragraph and shall state
				eligibility requirements, limitations on the conversion, and the benefits
				provided.
Statutory Authority: §§ 12.1-13 and 38.2-223 of
					 the Code of Virginia.