Administrative Code

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Virginia Administrative Code
Title 14. Insurance
Agency 5. State Corporation Commission, Bureau of Insurance
Chapter 120. Rules Governing the Implementation of the Individual Accident and Sickness Insurance Minimum Standards Act with Respect to Specified Disease Policies

14VAC5-120-80. Required disclosure provisions.

A. Each specified disease policy shall include a renewal provision as required by subdivision 2 of 14VAC5-120-50. The language or specifications of such provision must be consistent with the type of contract to be issued. Such provision shall be appropriately captioned and shall appear on the first page of the policy.

B. Except for riders or endorsements by which the insurer fulfills 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 an accompanying increase in premium during the policy term must be agreed to in writing signed by the insured, except if the increased benefits or coverage is required by law.

C. 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 or on an attached policy schedule page.

D. 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 an explanation of such terms.

E. If a policy contains any limitations with respect to preexisting conditions such limitations must appear as a separate paragraph of the policy and be labeled as "Preexisting Condition Limitations."

F. If a policy contains a conversion privilege it shall comply, in substance, with the following:

1. The caption of the provision shall be "Conversion Privilege," or words of similar import;

2. 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;

3. 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.

G. All specified disease 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 a limited policy. Read it carefully".

Statutory Authority

§§ 38.1-514, 38.2-3516 through 38.2-3520 of the Code of Virginia.

Historical Notes

Derived from Regulation 21, Case No. INS810010, § 9, eff. June 1, 1981.

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