TITLE 41

INSURANCE

CHAPTER 42

INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES

41-4205.  Outline of coverage. (1) In order to provide for full and fair disclosure in the sale of individual disability insurance policies, group supplemental disability insurance policies, nongroup subscriber contracts of a nonprofit hospital, medical or dental service association, or nongroup subscriber contracts of managed care organizations, no such policy or contract shall be offered, delivered, issued for delivery, continued or renewed in this state unless:

(a)  In the case of a direct response insurance product, the outline of coverage described in subsection (2) of this section accompanies the policy;

(b)  In all other cases, the outline of coverage described in subsection (2) of this section is delivered to the applicant at the time application is made and an acknowledgment of receipt of certificate of delivery of such outline is provided the insurer with the application. In the event the policy is issued on a basis other than that applied for, the outline of coverage properly describing the policy or contract must accompany the policy or contract when it is delivered and clearly state that it is not the policy or contract for which application was made.

(2)  The director shall prescribe the format and content of the outline of coverage required by subsection (1) of this section. "Format" means style, arrangement, and overall appearance, including such items as the size, color, and prominence of type and the arrangement of text and captions. Such outline of coverage shall include:

(a)  A statement identifying the applicable category or categories of coverage provided by the policy or contract as prescribed in section 41-4204, Idaho Code;

(b)  A description of the principal benefits and coverage provided in the policy or contract;

(c)  A statement of the exceptions, reductions and limitations contained in the policy or contract;

(d)  A statement of the renewal provisions including any reservation by the insurer, nonprofit hospital, medical or dental service association or managed care organization of a right to change premiums;

(e)  A statement that the outline is a summary of the policy, certificate or contract issued or applied for and that the policy, certificate or contract should be consulted to determine governing contractual provisions.

History:

[41-4205, added 1975, ch. 205, sec. 5, p. 569; am. 2009, ch. 66, sec. 5, p. 189.]