N.H. Admin. Code § Ins 6204.06
An outline of coverage, in the format prescribed below, shall be issued in connection with policies meeting the standards of this part. The items included in the outline of coverage shall appear in the following sequence:
[COMPANY NAME]
[SPECIFIED DISEASE COVERAGE]
THIS [POLICY] [CERTIFICATE] PROVIDES LIMITED BENEFITS
BENEFITS PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES
OUTLINE OF COVERAGE
This coverage is designed only as a supplement to a comprehensive health insurance policy and should not be purchased unless you have this underlying coverage. Persons covered under Medicaid should not purchase it. Read the NAIC's Shopper's Guide to Cancer Insurance to review the possible limits on benefits in this type of coverage.
Read Your [Policy] [Certificate] Carefully-this outline of coverage provides a very brief description of the important features of coverage. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR [POLICY] [CERTIFICATE] CAREFULLY!
[Specified disease] coverage is designed to provide, to persons insured, restricted coverage paying benefits ONLY when certain losses occur as a result of [specified diseases]. Coverage is not provided for basic hospital, basic medical-surgical, or major medical expenses.
[A brief specific description of the benefits, including dollar amounts and any exclusions.]
N.H. Admin. Code § Ins 6204.06