Section 2540.6 - Standard Supplemental Disclosure Forms for Use with Certificates(a) Generally. Supplemental disclosure forms for use with certificates shall be in the format set forth below and shall contain no material of an advertising nature except for the logotype of the organization or organizations providing the coverage. Disclosure forms which are physically incorporated into certificates, advertisements or advance announcements of coverage shall not be intermingled with the text of such documents and shall be given prominence relative to that of surrounding text. Disclosure forms which are delivered with certificates shall appear on or be attached to the front cover or inside front pages of the certificates or they may precede the portions of the certificates which set forth the benefits subject to this Article. Disclosure forms for use with "blanket" coverages shall accompany certificates or memorandums of coverage if or when they are delivered to insurers, subscribers or employees.(b) Drafting Instructions. Supplemental disclosure forms for use with certificates shall be plainly printed in no smaller than 11-point type and shall contain an appropriate caption or heading such as "Outline of Coverage." Such forms shall prominently state the organization or organizations providing the coverage and shall be introduced by a brief statement to the effect that the form is only a summary of the provisions of the certificate which, itself, must be consulted for the important details of the coverage provided. The information required to be disclosed by this section shall be set forth in separate provisions which shall be in the order set forth below. Each provision shall contain a caption or heading which reflects its subject matter. (1) Categories of Coverage. The first provision shall state the category or categories of coverage provided by the certificate, selected from those defined in Section 2540.5, subsections (b) through (k), above.(2) Benefits. The second provision shall briefly describe the benefits provided by the coverage or shall state the location or locations in the certificate where such benefits are disclosed. If benefits are set forth in the disclosure form, they shall be accompanied by disclosure of any elimination periods, deductible amounts or co-payment requirements applicable to the benefits described.(3) Exceptions, Reductions and Limitations. The third provision shall briefly describe the exceptions, reductions and limitations to which the coverage is subject or shall state the location or locations in the certificate where such exceptions, reductions or limitations are described. Provisions which may have the effect of reducing benefits otherwise payable because of other coverage are deemed to be "reductions" for the purpose of this provision. Where exceptions, reductions and limitations are described in the certificate in conjunction with the description of benefits, this provision may contain a statement directing the covered person to refer to the benefit descriptions in the certificate.(4) Continuation of Coverage. The fourth provision shall briefly describe the provisions in the certificate relating to eligibility for coverage and continuation and termination of coverage or shall state the location or locations of such provisions in the certificate.(5) Premium or Contribution. The fifth provision shall disclose information relative to the premium or contribution paid by the insured, subscriber or employee for disability coverage. Where such premium or contribution is identifiable, its amount in effect at the time the disclosure form is delivered shall be disclosed. Alternatively, this provision may state where such information may be obtained (for example, statements of wages and deductions accompanying employee paychecks or premium notices). Where the premium or contribution for disability coverage is not identifiable because it is combined with the costs of other coverages not subject to this Article, this provision may be limited to a statement to the effect that the cost of the coverage is included within the premium or contribution paid by the insured, subscriber or employee for his benefit plan. This paragraph may be omitted if the coverage is provided without charge to the insured, subscriber or employee.(c) Medicare Supplement Coverage. Supplemental disclosure forms for use with certificates providing Medicare supplement coverage as defined in Section 2220.51 shall comply with Sections 2540.3 and 2540.5 in lieu of subsections (a) and (b) of this Section. Such disclosure forms may (1) use terms appropriate to group coverage in place of terms more appropriate to individual coverage and (2) may identify the master policyholder, but not so as to give more prominence to the master policyholder than to the insurer. Supplemental disclosure forms for use with combination certificates which provide comprehensive or major medical hospital, medical and surgical coverage to those under 65 and Medicare supplement coverage to those over age 65 are exempt from this subsection.Cal. Code Regs. Tit. 10, § 2540.6
1. New section filed 1-8-76; effective thirtieth day thereafter (Register 76, No.2).
2. New subsection (c) filed 3-31-83; effective thirtieth day thereafter (Register 83, No. 14). Note: Authority cited: Sections 790.10, 10195(g) and 10608, Insurance Code. Reference: Sections 10195 (g) and 10603, Insurance Code.
1. New section filed 1-8-76; effective thirtieth day thereafter (Register 76, No.2).
2. New subsection (c) filed 3-31-83; effective thirtieth day thereafter (Register 83, No. 14).