Section Ins 6201.06 - Outline of Coverage Requirements(a) An insurer shall deliver an outline of coverage to an applicant or enrollee in the sale of individual ancillary health insurance, group ancillary health insurance, dental plans, and vision plans as required in RSA 415-A:4(b) If an outline of coverage was delivered at the time of application or enrollment and the policy or certificate is issued on a basis which would require revision of the outline, a revised outline of coverage properly describing the policy or certificate shall accompany the policy or certificate when it is delivered and contain the following statement in no less than 14 point type, immediately above the company name: "NOTICE: Read this outline of coverage carefully. It is not identical to the outline of coverage provided upon [application] [enrollment], and the coverage originally applied for has not been issued."
(c) In any case where the prescribed outline of coverage is inappropriate for the coverage provided by the policy or certificate, an alternative outline of coverage shall be submitted to the commissioner prior to use.(d) Advertisements shall fulfill the requirements for outlines of coverage if they satisfy the standards specified for outlines of coverage in RSA 415-A:4 as well as this part.(e) The outline of coverage shall not refer back to the policy for exclusions and limitations but shall specify exclusions and limitations in the outline of coverage.(f) Policies for persons eligible for Medicare: (1) Outlines of coverage delivered in connection with policies that provide hospital confinement indemnity, specified disease, or limited benefit health coverage to persons eligible for Medicare by reason of age shall contain the following language, which shall be printed on or attached to the first page of the outline of coverage: "This IS NOT A MEDICARE SUPPLEMENT policy. If you are eligible for Medicare, review the Guide to Health Insurance for People With Medicare available from the company."; and
(2) An insurer shall deliver to persons eligible for Medicare any notice required under RSA 415-F:5 and Ins 1905.19(e) Notice Regarding Policies or Certificates Which Are Not Medicare Supplement Policies.(g) An outline of coverage, in the format prescribed in (h) below, shall be issued in connection with policies meeting the standards of this part.(h) The items included in the outline of coverage shall appear in the following sequence: "[COMPANY NAME]
[TYPE OF ANCILLARY HEALTH COVERAGE]
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES
OUTLINE OF COVERAGE
Read Your [Policy] [Certificate] Carefully-this outline of coverage provides a very brief description of the important features of coverage. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR [POLICY] [CERTIFICATE] CAREFULLY!
[Type of Ancillary Health] coverage is designed to provide, to persons insured, [brief description of Type of Ancillary Health coverage], subject to any limitations set forth in the policy or certificate. Coverage is not provided for any benefits other than the specific [Type of Ancillary Health] benefits described and any additional benefit described below:
(1) [A brief specific description of the benefits, including dollar amounts];(2) [A description of any policy provisions that exclude, eliminate, restrict, reduce, limit, delay, or in any other manner operate to qualify payment of the benefit described in paragraph (1) above]; and(3) [A description of policy provisions respecting renewability of continuation of coverage, including age restrictions or any reservation of right to change premiums]."N.H. Admin. Code § Ins 6201.06
Derived From Volume XXXVIII Number 32, Filed August 9, 2018, Proposed by #12600, Effective 8/3/2018, Expires 8/3/2028.