NAC695F.470. Summary of coverage: Filing, contents and delivery of disclosure.

     1. An organization shall file with the Commissioner, for his or her approval, a disclosure summarizing the coverage provided by a limited health service plan offered by the organization.

     2. The disclosure must:

     (a) Be in at least 10-point type;

     (b) Include the name, address and telephone number of the organization;

     (c) Include the name, address and telephone number of the agent, broker and administrator, if applicable;

     (d) Include a statement describing the principal benefits and the type of coverage being provided;

     (e) Include a description of any provision of the plan which significantly excludes, eliminates, reduces or in any other manner operates to limit the payment of the benefits;

     (f) Include a statement concerning the renewal provisions of the plan; and

     (g) Define the term “usual and customary” or any similar term used in the plan.

     3. The agent for the organization, the organization after a response to a direct-response solicitation or the broker representing the group policyholder shall deliver the approved disclosure summary to the proposed group policyholder before the limited health service plan is issued.

     (Added to NAC to Comm’r of Insurance, eff. 2-3-97)