§ 88.189. Hospital confinement indemnity coverage form.
An outline of coverage, in the form prescribed in this section, shall be issued in connection with policies meeting the standards of § 88.164 of this title (relating to hospital confinement indemnity coverage). The items included in the outline must appear in the sequence prescribed:
(COMPANY NAME)
(HOME OFFICE ADDRESS)
HOSPITAL CONFINEMENT INDEMNITY COVERAGE
REQUIRED OUTLINE OF COVERAGE(1) Read Your Policy Carefully—This outline provides a very brief description of the important features of your policy. 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 CAREFULLY!
(2) Hospital Confinement Indemnity Coverage—Policies of this category are designed to provide, to persons insured, coverage in the form of a fixed daily benefit during periods of hospitalization resulting from a covered accident or sickness, subject to any limitations set forth in the policy. Such policies do not provide any benefits other than the fixed daily indemnity for hospital confinement. (*NOTE: Immediately preceding sentence may be appropriately modified, if necessary, to reflect coverage provided.)
(3) (A brief specific description of the benefits contained in this policy, in the following order:
(a) Daily benefit payable during hospital confinement; and
(b) Duration of benefit described in (a).
(c) Any other benefits provided by the policy.
*NOTE: The above description of benefits shall be stated clearly and concisely, and shall include a description of benefit amounts, durations or limits, elimination periods, inner limits, deductible or co-payment provisions and any other items appropriate to the coverage provided.)
(4) (A description of the exceptions, reductions and limitations contained in the policy or contract, including the pre-existing conditions provisions, if any, and the circumstances under which any reduction becomes operative.)
(5) (A description of the terms and conditions of renewability of the policy or contract, including any limitation by age, time or event, rights to change premium, status requirements and any other matters appropriate to the terms and conditions of renewability (including any rights of cancellation reserved to the insured).)
Cross References This section cited in 31 Pa. Code § 88.171 (relating to supplemental insurance coverage).
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