1-Exhibit 1 - HI Ballot Language.pdf
PDF 209 KB Posted
- Attached to
- Medical Rx Point Solutions State and local contract opportunity
- Solicitation number
- 3581-7
- Issued by
- Maricopa County, Arizona
About this file
This document is an enrollment disclosure exhibit establishing federal regulatory requirements for Hospital Indemnity Insurance enrollment language across multiple states. The file specifies mandatory disclosures that must be prominently displayed on the first page of enrollment experiences in at least 14-point font with contrasting colors, explaining that Hospital Indemnity is a fixed indemnity policy rather than comprehensive health insurance. The disclosure clarifies that coverage provides limited dollar amounts for sickness or hospitalization, does not cover the full cost of care, and may include annual payment limits. The document applies to all states except California, Colorado, Minnesota, New Hampshire, New Mexico, New York, Pennsylvania, and Vermont, with alternative language requirements noted for those specific jurisdictions.
The enrollment language requires participants to acknowledge receipt and understanding of coverage outlines, declare the accuracy of provided information, and confirm they have read applicable fraud warnings. For Minnesota and Vermont residents, participants must declare that all insured individuals maintain existing medical coverage providing hospital, surgical, and medical expense benefits. The document emphasizes that this fixed indemnity policy is not a substitute for comprehensive health insurance and does not include federal consumer protections applicable to health insurance plans. Participants are directed to HealthCare.gov or the State Department of Insurance for questions or complaints regarding coverage options and policy inquiries.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 4-Exhibit 4 - Census MCCCD Nov2025 Revised.xlsx | XLSX spreadsheet | |
| 5-3581-7 RFP Medical Rx Point Solutions.pdf | ||
| 3-Exhibit 3 - MedClaims Detail 2024Incurred MCCCD Bid Project.csv | CSV file | |
| 2-Exhibit 2 -Monthly Claims Enrollment 2023-24.xlsx | XLSX spreadsheet |
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Text version
Exhibit 1
All states, except CA, CO, MN, NH, NM, NY, PA and VT
Enrollment Regulatory Requirement for
Hospital Indemnity
Requirement
Federal regulation requires that the following disclosure (following this page) be provided to participants at or before the time they enroll or re-enroll in coverage. The regulation indicates the disclosure must be prominently displayed on the “first page” of the enrollment experience, in at least 14-point font. The regulation defines “prominently displayed” to include criteria such as:
using font colors that contrast with background to make it more visible; not requiring that someone click on a link to view it; and not obscuring it with other text or graphics. The heading that appears above the disclosure clarifying that the notice applies to Hospital Indemnity may be omitted as needed if the enrollment experience addresses only Hospital Indemnity.
This notice applies to Hospital Indemnity Insurance. In certain states, this coverage may be referred to as Accident and Sickness Insurance.
IMPORTANT: This is a fixed indemnity policy, NOT health insurance
This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.
• The payment you get isn’t based on the size of your medical bill.
• There might be a limit on how much this policy will pay each year.
• This policy isn’t a substitute for comprehensive health insurance.
• Since this policy isn’t health insurance, it doesn’t have to include most Federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
• Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
• To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about this policy?
• For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (naic.org) under “Insurance Departments.”
• If you have this policy through your job, or a family member’s job, contact the employer.
Hospital Indemnity Enrollment Language (Please note the language below should appear before completing enrollment)
Your Hospital Indemnity certificate provides limited benefits – read your certificate carefully when you receive it. Hospital Indemnity Insurance may be referred to as Accident and Sickness
Insurance in Colorado – please consult your enrollment materials. By enrolling for Hospital
Indemnity Insurance, if I am a resident of Minnesota or Vermont, I declare all individuals to be insured have medical coverage in force that provides benefits for medical treatment, including hospital, surgical and medical expenses. I acknowledge that I have received and read a copy of the outline of coverage or other disclosure document for the Hospital Indemnity insurance. In addition, I have read the enrollment documentation and declare that all information I have given is true and complete to the best of my knowledge and belief; I have read the applicable
Fraud Warning(s) provided in this enrollment.
File details come from the government source that posted it. Updated .