Regulation .03 Rules for Providing the Medical Stop-Loss Insurance Disclosure Form.
Regulation .03 Rules for Providing the Medical Stop-Loss Insurance Disclosure Form.LinkCopy Citation
A.
Before entering into a policy or contract of medical stop-loss insurance with a small employer, a carrier shall provide the small employer a completed medical stop-loss insurance disclosure form.
B.
When determining whether an employer satisfies the definition of a small employer, the carrier shall base the determination on the definition that applies on the proposed effective date of the medical stop-loss insurance policy or contract.
C.
The medical stop-loss insurance disclosure form shall be printed in at least 12-point type.
D.
The portion of the medical stop-loss insurance disclosure form that requires a listing of any limitations in the medical stop-loss insurance policy or contract is required to include any:
(1)
Dollar limitations in the medical stop-loss insurance policy or contract, such as annual limitations;
(2)
Day or visit limits on the services covered under the medical stop-loss insurance policy or contract;
(3)
Limitations or exclusions that apply to benefits covered under the medical stop-loss insurance policy or contract, such as:
(a)
Pre-existing condition exclusions;
(b)
Exclusions or limitations for particular services, such as an exclusion or limitation for prescription drugs or mental health services;
(c)
Exclusions or limitations for particular medical conditions, such as AIDS;
(d)
Limitations or exclusions for non-medically necessary services; and
(e)
Limitations or exclusions for experimental or investigational services; and
(4)
Different attachment points for any particular service, such as organ transplants.