Conversion and individual agreements must contain the following
additional mandatory provisions:
(1) Reinstatement. A provision clearly setting forth
the requirements for reinstatement and disclosing how reinstatement
changes or affects the rights and coverages originally provided. New
evidence of insurability may be required.
(2) Ten days to examine agreement. A provision stating
that the contract holder may return the contract within 10 days of
receiving it and have the premium paid refunded if, after examination
of the contract, the contract holder is not satisfied with it for
any reason. If the contract holder returns the contract to the issuing
HMO or to the agent through whom it was purchased, then the contract
is considered void from the beginning and the parties are in the same
position as if no contract had been issued. If services are rendered
or claims paid by the HMO during the 10 days, the subscriber is responsible
for repaying the HMO for the services or claims.
(3) Consideration. The original consideration, including
premiums, application fee, and any other amounts to be paid for coverage,
must be expressed in the agreement or in the application.
(4) Continuance of coverage due to change in marital
status. A provision stating that if a person loses coverage due to
a change in marital status, that person will be issued coverage in
compliance with §21.407 of this title (relating to Continuance
of Coverage).
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