N.H. Code Admin. R. Ins 1902.07 - Required Disclosure Provisions

(a) All medicare supplement policies shall include the following general rules:

(1) Medicare supplement policies shall include a renewal or continuation provision which shall be consistent with the type of contract issued, captioned, and shall appear on the first page of the policy;

(2) A medicare supplement policy which provides for the payment of benefits based on standards described as "usual and customary," "reasonable and customary," or words of similar import, shall include a definition of such terms and an explanation of such terms in its accompanying outline of coverage;

(3) If a medicare supplement policy contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the policy and be labeled as "preexisting condition limitations";

(4) All medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate attached thereto stating that the policyholder or certificateholder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the insured person is not satisfied for any reason;

(5) Except as otherwise provided in this part, the terms "medicare supplement," "medigap" and words of similar import shall not be used unless the policy is issued in compliance with Ins 1902.06; and

(6) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured, exercises a specifically reserved right under a medicare supplement policy, or is required to reduce or eliminate benefits to avoid duplication of medicare benefits, all riders or endorsements added to a medicare supplement policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the insured. After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the insured, unless the benefits are required by the minimum standards for medicare supplement policies, or if the increased benefits or coverage is required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, such premium charge shall be set forth in the policy.

(b) The following notice requirements shall be met:

(1) As soon as practicable, but not later than 30 days prior to the annual effective date of any medicare benefit changes, every insurer, health care service plan, or other entity providing medicare supplement insurance or benefits to a resident of this state shall notify its policyholders, contractholders and certificateholders of modifications it has made to medicare insurance policies or contracts;

(2) The notice required by (1) above shall:

a. Include a description of revisions to the medicare program and a description of each modification made to the coverage provided under the medicare supplement insurance policy or contract; and

b. Inform each covered person as to when any premium adjustment is to be made due to changes in medicare;

(3) The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and simple terms so as to facilitate comprehension; and

(4) Such notices shall not contain or be accompanied by any solicitation.

(c) Medicare supplement policies shall contain the following information:

(1) Insurers issuing medicare supplement policies or certificates for delivery in this state shall provide an outline of coverage to all applicants at the time application is made and, except for direct response policies, shall obtain an acknowledgment of receipt of such outline from the applicant; and

(2) If an outline of coverage is provided at the time of application and the medicare supplement policy or certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or certificate shall accompany such policy or certificate when it is delivered and contain the following statement, in no less than 12 point type, immediately above the company name: "It is not identical to the outline of coverage provided upon application and the coverage originally applied for has not been issued;" and

(3) In addition to the requirements of subparagraphs (1) and (2), insurers issuing medicare supplement policies or certificates shall provide an outline of coverage for such medicare supplement policies or certificates to any prospective purchaser upon request.

(d) Notice regarding policies or subscriber contracts which are not medicare supplement policies shall include:

(1) The following in no less than 12 point type, either printed or attached to the first page of the outline of coverage delivered to insureds under the policy or subscriber contract, or if no outline of coverage is delivered, to the first page of the policy, certificate or subscriber contract delivered to insureds: "This, policy, certificate or subscriber contract, is not a medicare supplement policy or certificate. If you are eligible for medicare, review the medicare supplement buyer's guide available from the company" on the following policies issued for delivery in this state to persons eligible for medicare:

a. Any accident and sickness insurance policy or subscriber contract, other than a medicare supplement policy;

b. A policy issued pursuant to a contract under section 1876 of the Federal Social Security Act 42 U.S.C. Section 1395 et seq., disability income policy;

c. Basic, catastrophic, or major medical expense policy; and

d. Single premium nonrenewable policy or other policy identified in Ins 1902.02(b) of this part.

Notes

N.H. Code Admin. R. Ins 1902.07

#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5119, eff 4-25-91; amd by #5421, eff 7-1-92; ss by #5656, eff 7-1-93; amd by #6405, eff 1-1-97; amd by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99

New. #8555, eff 2-1-06

Amended by Volume XXXVI Number 06, Filed February 11, 2016, Proposed by #11014, Effective 1/8/2016, Expires 1/8/2026.