(a) Each nonprofit health service plan that provides hospital benefits shall furnish a statement of the plan’s principal claims practices as part of the certificate form or booklet describing the coverage to be afforded.

(b) The statement shall include practices for payment for:

(1) surgical procedures performed by two or more surgeons;

(2) services provided in-area by nonparticipating providers; and

(3) services provided out-of-area by affiliated plans and affiliated providers.