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Virginia Administrative Code
Title 14. Insurance
Agency 5. State Corporation Commission, Bureau of Insurance
Chapter 140. Rules Governing the Implementation of the Individual Accident and Sickness Insurance Minimum Standards Act
8/5/2020

14VAC5-140-80. Required Disclosure Provisions.

A. General rules for all policies.

1. Each individual policy of accident or sickness insurance shall include a renewal, continuation or nonrenewal provision. The language or specifications of such provision shall be consistent with the type of contract to be issued. Such provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.

2. 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 the 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 the date of policy issue, any rider or endorsement which increases benefits or coverage with an accompanying increase in premium during the policy term shall be agreed to in writing signed by the insured, except if the increased benefits or coverage is required by law.

3. 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.

4. 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.

5. 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 Conditions Limitation."

6. If age is to be used as a determining factor for reducing the maximum aggregate benefits made available in the policy as originally issued, such fact must be prominently set forth in the policy.

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

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

b. 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;

c. The provision shall specify the benefits to be provided on conversion or may state that the converted coverage shall be as provided on a policy form then being used by the insurer for that purpose.

B. Rules for limited benefit policies, other than accident only or specified accident only policies. The following disclosure requirements shall be met by all limited benefit policies:

1. A cover sheet, containing only the following information shall be permanently attached to the front of the policy:

COMPANY NAME

LOGO (OPTIONAL)

NOTICE: LIMITED BENEFIT DISCLOSURE FORM. THE POLICY DESCRIBED IN THIS COVER SHEET DOES NOT MEET THE MINIMUM STANDARDS REQUIRED BY THE BUREAU OF INSURANCE, VIRGINIA STATE CORPORATION COMMISSION, FOR INDIVIDUAL ACCIDENT AND SICKNESS POLICIES. (This notice must be in capital letters and in no less than 14-point type.)

Minimum standards were established by the Bureau to insure the availability of health insurance contracts providing a minimum of basic benefits needed for health care. This policy does not meet the Virginia minimum standards for the following reason(s): (A listing of the reason(s) shall be furnished by the Bureau at the time the contract is reviewed and the actual Bureau language shall be used.)

(The following language shall be required for an insurer, other than a direct response insurer.) I have read this cover sheet and realize that this policy does not meet minimum standards required by Virginia law and that it can only be sold as a LIMITED BENEFIT POLICY.

Signature

FORM NUMBER

This is a disclosure form. It is not part of the policy to which it is attached.

2. The cover sheet shall contain one duplicate copy to be maintained by the insurance company for the length of time that the policy is in force or for three years, whichever is greater.

C. Rules for accident and specified accident only policies. The following disclosure requirement shall be met by all accident only and specified accident only policies:

Insurers have the option of (i) printing, clearly stamping or printing on gum labels on the first page of the policy, (ii) attaching a cover sheet to the front of the policy or (iii) adding to their outline of coverage, which shall be attached to the front of the policy, the following information:

NOTICE: THIS IS A LIMITED BENEFIT POLICY. IT DOES NOT PAY ANY BENEFITS FOR LOSS FROM SICKNESS. THIS POLICY PROVIDES RESTRICTIVE COVERAGE FOR CERTAIN LOSSES WHICH OCCUR AS A RESULT OF (AN ACCIDENT) (A SPECIFIED ACCIDENT) ONLY. (This notice shall be in capital letters and in no less than 14-point type.)

Statutory Authority

§§ 12.1-13, 38.2-223, and 38.2-3516 of the Code of Virginia.

Historical Notes

Derived from Regulation 19, Case No. INS880413, § 9, eff. January 1, 1989; amended, Volume 18, Issue 21, eff. July 1, 2002.

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