§ 4028. Form and contents of policy
No policy of individual health insurance shall be delivered or issued for delivery
to any person in this State unless all of the following conditions are met:
(1) The policy sets forth all of the monetary and other considerations for the policy.
(2) The policy sets forth the time at which the insurance takes effect and terminates.
(3) The policy purports to insure only one person, except that a policy may insure, originally
or by subsequent amendment, upon the application of an adult member of a family who
shall be deemed the policyholder, any two or more eligible members of that family,
including a spouse or civil union partner, dependent children or any children under
a specified age that shall not exceed 26 years of age, and any other person dependent
upon the policyholder.
(4) The style, arrangement, and overall appearance of the policy give no undue prominence
to any portion of the text, and every printed portion of the text of the policy and
of any endorsements or attached papers is plainly printed in light-faced type of a
style in general use, the size of which shall be uniform and not less than 10-point
with a lowercase unspaced alphabet length not less than 120-point. As used in this
subdivision, the “text” includes all printed matter except the name and address of
the insurer; the name or title of the policy; the brief description, if any; and the
captions and subcaptions.
(5) The exceptions and reductions of indemnity are set forth in the policy and, except
those that are set forth in sections 4029 and 4030 of this title, are printed, at the insurer’s option, either with the benefit provision to which
they apply or under an appropriate caption such as “EXCEPTIONS” or “EXCEPTIONS AND
REDUCTIONS”; provided, however, that if an exception or reduction specifically applies
only to a particular benefit of the policy, the statement of the exception or reduction
shall be included with the benefit provision to which it applies.
(6) Each policy form, including riders and endorsements, is identified by a form number
in the lower left-hand corner of the first page of the form.
(7) The policy does not contain any provision purporting to make any portion of the charter,
rules, constitution, or bylaws of the health insurer a part of the policy unless that
portion is set forth in full in the policy, except in the case of the incorporation
of, or reference to, a statement of rates or classification of risks or a short-rate
table filed with the Commissioner.
(8) Either prominently printed on or attached to the first page of the policy is a notice
to the effect that during a period of 30 days following the date the policy is delivered
to persons eligible for Medicare by reason of age, and 10 days following the date
of delivery to all other persons, the policy may be surrendered to the insurer together
with a written request for cancellation of the policy, and that in such event, the
insurer will refund any premium paid, including any policy fees or other charges;
provided, however, that this subdivision shall not apply to single premium nonrenewable
policies insuring against accident only or medical costs or accidental bodily injury
only. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)