Ins 3.13(2)(e)(e)
Ins 3.13(2)(e)1.1. The terms “non-cancellable” or “non-cancellable 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:
Ins 3.13(2)(e)1.a.a. Until at least age 50, or
Ins 3.13(2)(e)1.b.b. In the case of a policy issued after age 44, for at least 5 years from its date of issue, 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.
Ins 3.13(2)(e)2.2. A non-cancellable or non-cancellable and guaranteed renewable policy form shall disclose, as prominently as and in close conjunction with any prominent use of the terms “non-cancellable” or “non-cancellable and guaranteed renewable:”
Ins 3.13(2)(e)2.a.a. The age to or term for which the form is non-cancellable or non-cancellable and guaranteed renewable, if other than lifetime,
Ins 3.13(2)(e)2.b.b. The age or time at which the form’s benefits are reduced, if applicable, (The age or time at which a form’s benefits are reduced need not be so disclosed if such reduction is not effected prior to the age to or term for which the form is non-cancellable or non-cancellable and guaranteed renewable or if regular benefits are payable at least to the age to or term for which the form is non-cancellable or non-cancellable and guaranteed renewable.) and
Ins 3.13(2)(e)2.c.c. That benefit payments are subject to an aggregate limit, if applicable.
Ins 3.13(2)(e)3.3. 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:
Ins 3.13(2)(e)3.a.a. Until at least age 50, or
Ins 3.13(2)(e)3.b.b. In the case of a policy issued after age 44, for at least 5 years from its date of issue, 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.
Ins 3.13(2)(e)4.4. A guaranteed renewable policy form shall disclose, as prominently as and in close conjunction with any prominent use of the term “guaranteed renewable:”
Ins 3.13(2)(e)4.a.a. The age to or term for which the form is guaranteed renewable, if other than lifetime,
Ins 3.13(2)(e)4.b.b. The age or time at which the form’s benefits are reduced, if applicable, (The age or time at which a form’s benefits are reduced need not be so disclosed if such reduction is not effected prior to the age to or term for which the form is guaranteed renewable or if regular benefits are payable at least to the age to or term for which the form is guaranteed renewable.)
Ins 3.13(2)(e)4.c.c. That benefit payments are subject to an aggregate limit, if applicable, and
Ins 3.13(2)(e)4.d.d. That the applicable premium rates may be changed.
Ins 3.13 NoteNote: “Prominent use” as referred to in subds. 2. and 4. is considered to include, but is not necessarily limited to, use in titles, brief descriptions, captions, bold-face type, or type larger than that used in the text of the form.
Ins 3.13(2)(e)5.5. The foregoing limitation on the use of the term “non-cancellable” shall also apply to any synonymous term such as “not cancellable” and the limitation on use of the term “guaranteed renewable” shall apply to any synonymous term such as “guaranteed continuable.”
Ins 3.13(2)(e)6.6. Nothing herein contained is intended to restrict the development of policies having other guarantees of renewability, or to prevent the accurate description of their terms of renewability or the classification of such policies as guaranteed renewable or non-cancellable for any period during which they may actually be such, provided the terms used to describe them in policy contracts and advertising are not such as may readily be confused with the above terms.
Ins 3.13(2)(e)7.7. The provisions of ss. 632.76 (1), 632.74 and 632.77 (3), Stats., are applicable to non-cancellable or non-cancellable and guaranteed renewable or guaranteed renewable policy forms as herein defined.
Ins 3.13(2)(f)(f) Policies issued on a family basis shall clearly set forth the conditions relating to termination of coverage of any family member.
Ins 3.13(2)(g)(g) Surgical benefit provisions or schedules shall provide that the benefit for any covered surgical procedure not specifically listed in the schedule and not excluded by the provisions of the policy shall be determined by the company on a basis consistent with the benefit provided for a comparable listed procedure.
Ins 3.13(2)(h)(h) A limited policy is one that contains unusual exclusions, limitations, reductions, or conditions of such a restrictive nature that the payments of benefits under such policy are limited in frequency or in amounts. All limited policies shall be so identified by having the words “THIS IS A LIMITED POLICY—READ IT CAREFULLY” imprinted or stamped diagonally across the face of the policy and the filing back, if any, in contrasting color from the text of the policy and in outline type not smaller than 18-point. When appropriate, these words may be varied by the insurer in a manner to indicate the type of policy; as for example, “THIS POLICY IS LIMITED TO AUTOMOBILE ACCIDENTS—READ IT CAREFULLY.” Without limiting the general definition above, policies of the following types shall be defined as “limited:” 1. School Accident, 2. Aviation Accident, 3. Polio, 4. Specified Disease, 5. Automobile Accident.
Ins 3.13(2)(i)(i) If the policy excepts coverage while the insured is in military or naval service, the policy must provide for a refund of pro rata unearned premium upon request of the insured for any period the insured is not covered. However, if coverage is excluded only for loss resulting from military or naval service or war, the refund provision will not be required. This section shall not apply to non-cancellable policies or non-cancellable and guaranteed renewable policies or guaranteed renewable policies.
Ins 3.13(2)(j)(j) Except as provided in s. Ins 3.39 (7) (d), (dm), and (dt), the provision or notice regarding the right to return the policy required by s. 632.73, Stats., shall comply with all of the following:
Ins 3.13(2)(j)1.1. Be printed on or attached to the first page of the policy,
Ins 3.13(2)(j)2.2. Have a caption or title which refers at least to the right to examine or to return the policy such as: “Right to Return Policy Within 10 Days of Receipt,” “Notice: Right to Return Policy,” “Right of Policy Examination,” “Right to Examine Policy,” “Right to Examine Policy for 10 Days,” “10 Day Right to Examine Policy,” “10 Day Right to Return Policy,” or “Notice of 10 Day Right to Return Policy,” or other wording, subject to approval by the commissioner, which is believed to be equally clear or more definite as to subject matter, and
Ins 3.13(2)(j)3.3. Provide an unrestricted right to return the policy, within 10 days from the date it is received by the policyholder, to the issuer at its home or branch office, if any, or to the agent through whom it was purchased; except it shall provide an unrestricted right to return the policy within 30 days of the date it is received by the policyholder in the case of a Medicare supplement policy subject to s. Ins 3.39 (4), (4m), (4t), (5), (5m), (5t), and (6), issued pursuant to a direct response solicitation. Provision shall not be made to require the policyholder to set out in writing the reasons for returning the policy, to require the policyholder to first consult with an agent of the issuer regarding the policy, or to limit the reasons for return.
Ins 3.13 NoteNote: Paragraph (j) was adopted to assist in the application of s. 204.31 (2) (a), Stats., to the review of accident and sickness policy and other contract forms. Those statutory requirements are presently included in s. 632.73, Stats. The original statute required that the provision of notice regarding the right to return the policy must be appropriately captioned or titled. Since the important rights given the insured are to examine the policy and to return the policy, the rule requires that the caption or title must refer to at least one of these rights—examine or return. Without such reference, the caption or title is not considered appropriate.