(1) Each Policy shall contain on its face page the actual title or titles reflecting the categories contained in Section 7.

(2) A “noncancellable”, “guaranteed renewable”, or “noncancellable and guaranteed renewable” Policy shall not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than non-payment of premium. The Policy shall provide that in the event of the insured's death, the spouse of the insured, if covered under the Policy, shall become the insured.

(3) The terms “noncancellable”, “guaranteed renewable”, or “noncancellable and guaranteed renewable” shall not be used without further explanatory language in accordance with the disclosure requirements of Section 8(A)(1). The terms “noncancellable” or “noncancellable and guaranteed renewable” may be used only in a policy which the insured has the right to continue in force by the timely payment of premiums set forth in the Policy until the age of sixty-five (65) or to eligibility for Medicare, during which period the insurer has no right to make unilaterally any change in any provision of the Policy while the Policy is in force; provided, however, any accident and health Policy which provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from accident or sickness may provide that the insured has the right to continue the Policy only to age sixty (60) if, at age sixty (60), the insured has the right to continue the Policy in force at least to age sixty-five (65) while actively or regularly employed. Except as provided above, the term “guaranteed renewable” may be used only in a Policy which the insured has the right to continue in force by the timely payment of premiums until the age of sixty-five (65) or to eligibility for Medicare, during which period the insurer has no right to make unilaterally any change in any provision of the Policy while the Policy is in force, except that the insurer may make changes in premium rates by classes; provided, however, any accident and health Policy which provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from accident or sickness may provide that the insured has the right to continue the Policy only to age sixty (60) if, at age sixty (60), the insured has the right to continue the Policy in force at least to age sixty-five (65) while actively and regularly employed.

(4) In a family Policy covering both husband and wife, the age of the younger spouse must be used as the basis for meeting the age and durational requirements of the definitions of “noncancellable, or “guaranteed renewable”. However, this requirement shall not prevent termination of coverage of the older spouse upon attainment of the stated age limit (e.g., age 65) so long as the Policy may be continued in force as to the younger spouse to the age or for the durational period as specified in said contract.

(5) When accidental death and dismemberment is part of the insurance coverage offered under the contract, the insured shall have the option to include all insureds under such coverage and not just the principal insured.

(6) If a Policy contains a status type military service exclusion or a provision which suspends coverage during military service, the Policy shall provide, upon receipt of written request, for refund of premiums as applicable to such person on a pro-rata basis.

(7) In the event the insurer cancels or refuses to renew, Policies providing pregnancy benefits shall provide for an extension of benefits as to pregnancy commencing while the Policy is in force and for which benefits would have been payable had the Policy remained in force.

(8) Policies providing convalescent or extended care benefits following hospitalization shall not condition such benefits upon admission to the convalescent or extended care facility within a period of less than fourteen (14) days after discharge from the hospital.

(9) Family coverage shall continue for any unmarried dependent child who is incapable of self sustaining employment due to mental retardation or physical handicap, on the date that such child's coverage would otherwise terminate under the Policy due to the attainment of a specified age limit (prior to the attainment of 19) for children and is chiefly dependent on the insured for support and maintenance. The coverage shall continue so long as the contract remains in force and so long as the dependent remains in such condition. Notice of such incapacity or dependency must be furnished to the insurer by the policyholder except in no event shall this notice requirement preclude eligible dependents under this regulation regardless of age.

(10) Any Policy coverage for the recipient in a transplant operation shall also provide reimbursement of any medical expenses of a live donor to the extent that benefits remain and are available under the recipient's Policy, after benefits for the recipient's own expenses have been paid.

(11) A Policy may contain a provision relating to recurrent disabilities provided; however, that no such provision shall specify that a recurrent disability be separated by a period greater than six (6) months.

(12) Accidental death and dismemberment benefits shall be payable if the loss occurs within ninety (90) days from the date of the accident, irrespective of total disability. However, no claim shall be denied wherein the insured with the use of extraordinary life support systems delays the loss for more than ninety (90) days from the date of the accident. Disability income benefits, if provided, shall not require the loss to commence less than thirty (30) days after the date of accident, nor shall any Policy which the insurer cancels or refuses to renew require that it be in force at the time disability commences if the accident occurred while the Policy was in force.

(13) Specific dismemberment benefits shall not be in lieu of other benefits unless the specific benefit equals or exceeds the other benefits.

(14) Any accident only Policy providing benefits which vary according to the type of accidental cause shall prominently set forth in the outline of coverage the circumstances under which benefits are payable which are lesser than the maximum amount payable under the Policy.

(15) Termination of the Policy shall be without prejudice to any continuous loss which commenced while the Policy was in force, but the extension of benefits beyond the period the Policy was in force may be predicated upon the continuous total disability of the insured, limited to the duration of the Policy benefit period, if any, or payment of the maximum benefits.

(16) If, to prevent overinsurance, benefits are reduced due to the presence of Medicare, then benefits may be reduced for those insureds actually covered by Medicare. Benefits may not be reduced based solely on eligibility for Medicare.

(1) daily hospital room and board in an amount not less than the lesser of (a) 80% of the charges for semi-private room accommodations or (b) $80.00 per day;

(2) miscellaneous hospital services for expenses incurred for the charges made by the hospital for services and supplies which are customarily rendered by the hospital and provided for use only during any one period of confinement in an amount not less than 80% of the charges incurred up to a maximum of at least $5,000.00 or thirty-one (31) times the daily hospital room and board benefits, whichever is the lesser; and

(3) hospital out-patient services consisting of (a) hospital services on the day surgery is performed, and (b) hospital services rendered within seventy-two (72) hours after accidental injury, in an amount not less than $80.00, and (c) x-ray and laboratory tests to the extent that benefits for such services would have been provided if rendered to an in-patient of the hospital;

(4) benefits provided under (1) and (2) of (B) above, may be provided subject to a combined deductible amount not in excess of $250.00.

(1) Surgical services

(2) Anesthesia services, consisting of administration of necessary general anesthesia and related procedures in connection with covered surgical service rendered by a physician other than the physician (or his assistant) performing the surgical services;

(3) In-hospital medical services, consisting of physician services rendered to a person who is a bed patient in a hospital for treatment of sickness or injury other than that for which surgical care is required, in an amount not less than 80% of the reasonable charges; or $25.00 per day for not less than thirty-one (31) days during one period of confinement.

(1) daily hospital room and board expenses, prior to application of the co-payment percentage for not less than $125.00 daily or the actual semi-private room rate which ever is less for a period of not less than thirty-one (31) days during continuous hospital confinement;

(2) miscellaneous hospital services, prior to application of the co-payment percentage, for an aggregate maximum not less than $5,000.00 or thirty-one (31) times the daily room and board rate if specified in dollar amounts;

(3) surgical services, prior to application of co-payment percentage to a maximum of not less than $1,600.00 for the most severe operation with the amounts provided for other operations reasonably related to such maximum amount;

(4) anesthesia services prior to application of the co-payment percentage, for a maximum of not less than 15% of the covered surgical fees or, alternatively, if the surgical schedule is based on relative values, not less than the amount provided therein for anesthesia services at the same unit value as used for the surgical schedule;

(5) in-hospital medical services, prior to application of the co-payment percentage, as defined in subdivision (C)(3) of Section 7;

(6) out of hospital care, prior to application of the co-payment percentage, consisting of physicians' services rendered on an ambulatory basis where coverage is not provided elsewhere in the Policy for diagnosis and treatment of sickness or injury, and diagnostic x-ray, laboratory services, radiation therapy, and hemodialysis ordered by a physician; and

(7) not fewer than three of the following additional benefits, prior to application of the co-payment percentage, for an aggregate maximum of such covered charges of not less than $3,200.00:

(1) provides that periodic payments which are payable at ages after 62 and reduced solely on the basis of age are at least 50% of the amounts payable immediately prior to 62.

(2) contains an elimination period no greater than:

(3) has a maximum period of time for which it is payable during disability of at least six (6) months except in the case of a Policy covering disability arising out of normal pregnancy or childbirth in which case the period for such disability may be one (1) month.

No reduction in benefits shall be put into effect because of an increase in Social Security or similar benefits during a benefit period. Section 7(F) does not apply to those Policies providing business buyout coverage.

(1) “Accident Only Coverage” is a Policy of accident and health insurance which provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by accident. Accidental death and double dismemberment amounts under such a policy shall be at least $1,000.00 and a single dismemberment amount shall be at least $500.00.

(2) “Specified Accident Coverage” is an accident insurance Policy which provides coverage for a specifically identified kind of accident (or accidents) for each person insured under the Policy for accidental death or accidental death and dismemberment, combined with a benefit amount not less than $1,000.00 for accidental death, $1,000.00 for double dismemberment and $500.00 for a single dismemberment.

(1) Specified Disease Coverage - See Appendix

(2) Cancer Coverage - See Appendix

(a) $45.00 per day from the first day;

(b) benefit period not less than 365 days; and

(c) requirement that insured be hospitalized for at least three (3) days and enter the facility within fourteen (14) days following hospital discharge.