The following text is typical of the language and provisions used on the first page of the Major Medical policy. Much of this information is required by state regulations and may vary by state.
(NOTE: In most, if not all, jurisdictions, the copy of the Application becomes part of the insurance contract/policy, again stressing the necessity of complete and accurate information on the Application)
Please carefully read the copy of your application attached to this Contract and notify Your Insurance Company, Inc. within 10 days if any information on it is incorrect or incomplete, or if any past medical history has been left out of the application. Your application is a part of your Contract, which has been issued on the basis that the answers to all questions and all information shown on the application are correct and complete.
This Contract Contains a Deductible Provision
(This statement required in most jurisdictions when applicable
(The following is the Identification section, and while the format may vary by company, it is the minimum required in most jurisdictions)
CONTRACT NUMBER: GROUP #
During the terms of this Contract, Your Insurance Company agrees to provide to covered individuals the health insurance benefits specifically provided in this Contract, subject to all the terms, conditions, limitations, and exclusions.
(The following refund statement or one very similar is used in used in most states, but this "10-day – no questions asked" provision is the most typical)
IF, AFTER EXAMINATION OF THIS CONTRACT AND COPY OF YOUR APPLICATION, YOU ARE NOT FULLY SATISFIED FOR ANY REASON, YOUR PREMIUM PAYMENT WILL BE REFUNDED PROVIDED YOU RETURN THE CONTRACT AND IDENTIFICATION CARDS TO YOUR INSURANCE COMPANY, INC.
This provision allows the company to cancel according to the provisions contained in the contract, but most states require that a statement of this type be on the first page.
This Contract will stay in effect as long as you remain eligible for coverage and you pay your Premiums on time, This Contract can be canceled if you have made a Fraudulent or Material Misrepresentation or omission on your application or we terminate the Contract for everyone covered by it.
We want you to understand and be satisfied with the terms of this Contract. As you read through it, remember that the words "we", "us" and "our" refer to Your Insurance Company, Inc., the insurer (hereinafter referred to as YOUR INSURANCE COMPANY). We use the words "you" and "your" to mean you, the Insured and your Covered Dependents.
We have issued this Contract in return for the completed application (which is made a part of this Contract) and initial Premium payment.
(NOTE: The above typically completes the first page of the contract. In some states, if a company is marketing their health insurance policies from an out-of-state trust (ERISA account), thereby removing or restricting the authority of the Department of Insurance to act in regards to that policy, some notification may be required. One state requires a statement to appear in red ink on the first page, which states essentially that the provisions of that policy are under the jurisdiction of another state other than the one in which the policy is issued. )
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