FORM OF LEGAL SERVICE CONTRACT AND REQUIRED DISCLOSURES

A legal service contract marketed, sold, offered for sale, administered, or issued in this state must: (1) be written, printed, or typed in clear, understandable language that is easy to read; (2) include the name and full address of the company; (3) include the purchase price of the contract and the terms under which the contract is sold; (4) include the terms and restrictions governing cancellation of the contract by the company or the legal service contract holder; (5) identify: (A) any administrator, if the administrator is not the company; (B) the sales representative; and (C) the name of the legal service contract holder; (6) include the amount of any deductible or copayment; (7) specify the legal services and other benefits to be provided under the contract, and any limitation, exception, or exclusion; (8) specify the legal services, if any, for which the company will provide reimbursement and the amount of that reimbursement; (9) specify any restriction governing the transferability of the contract or the assignment of benefits; (10) include the duties of the legal service contract holder; (11) explain the method to be used in resolving the legal service contract holder's complaints and grievances; (12) explain how legal services may be obtained under the legal service contract; (13) include a provision stating that no change in the contract is valid until the change has been approved by an executive officer of the company and unless the approval is endorsed or attached to the contract; (14) include any eligibility and effective date requirements, including a definition of eligible dependents and the effective date of their coverage; (15) include the conditions under which coverage will terminate; (16) explain any subrogation arrangements; (17) contain a payment provision that provides for a grace period of at least 31 days; and (18) include conditions under which contract rates may be modified.