Subject to the provisions and conditions of this rule, if the group insurance policy from which conversion is made insures the employee or member for basic hospital or surgical expense insurance, the employee or member shall be entitled to obtain a converted policy providing coverage on an expense-incurred basis under plans meeting the following requirements:
(a) hospital room and board daily expense benefits in a maximum dollar amount approximately the average semi-private rate charged in metropolitan areas of this state, for a maximum duration of seventy days,
(b) miscellaneous hospital expense benefits of a maximum amount of ten times the hospital room and board daily expense benefits, and
(c) surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars, or
(a) hospital room and board daily expense benefits in a maximum dollar amount equal to 75% of the maximum dollar amount determined for Plan A, for a maximum duration of seventy days,
(b) miscellaneous hospital expense benefits of a maximum amount of ten times the hospital room and board daily expense benefits, and
(c) surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars, or
(a) hospital room and board daily expense benefits in a maximum dollar amount equal to 50% of the maximum dollar amount determined for Plan A, for a maximum duration of seventy days,
(b) miscellaneous hospital benefits of a maximum amount of ten times the hospital room and board daily expense benefits, and
(c) surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars.
The maximum dollar amount in Plan A is determined to be $150.00. A redetermination may be made once in three years (3). The maximum dollar amounts in Plan A, B and C shall be rounded to the nearest multiple of $10.00.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
