W. Va. Code R. agency 114, tit. 114, ser. 114-12, app D
[COMPANY NAME]
HOSPITAL CONFINEMENT INDEMNITY COVERAGE
OUTLINE OF COVERAGE
(1) Read Your Policy Carefully. -- This outline of coverage provides a very brief description of the important features of your policy. This is not the insurance policy, and only the actual policy provisions will control. The policy itself sets forth in detail the rights and obligations of both you and your insurer. It is, therefore, important that you Read Your Policy Carefully!
(2) Hospital Confinement Indemnity Coverage. -- Policies of this category are designed to provide, to persons insured, coverage in the form of a fixed daily benefit during periods of hospitalization resulting from a covered accident or sickness, subject to any limitations, deductibles and copayment requirements set forth in the policy. Such policies do not provide any benefits other than the fixed daily indemnity for hospital confinement. [Note: Final sentence may be appropriately modified to reflect additional benefits provided, if any.]
(3) [A brief specific description of the benefits contained in this policy, in the following order:
(a) Daily benefit payable during hospital confinement; and
(b) Duration of benefit described in (a) above.
(4) [A description of any policy provisions which exclude, eliminate, restrict, reduce, limit, delay or in any other manner operate to qualify payment of the benefit described in paragraph (3) above.]
(5) [A description of policy provisions respecting renewability or continuation of coverage, including age restrictions or any reservation of right to change premiums.]
(6) [Any benefits provided in addition to the daily hospital confinement indemnity benefit.]
NOTE: In the outline of coverage forms that follow, only the material appearing in brackets is to be composed by the insurer in language appropriate for the coverage provided. All other material shall appear in exactly the form set forth in this rule.
W. Va. Code R. agency 114, tit. 114, ser. 114-12, app D