Utah Admin. Code R590-146-17 - Required Disclosure Provisions
(1)
(a) A
policy or certificate shall include a renewal or continuation provision. The
language or specifications of the provision shall be consistent with the type
of policy issued. The provision shall be appropriately captioned, appear on the
first page of the policy or certificate, and include any reservation by the
issuer of the right to change premiums and any automatic renewal premium
increases based on the insured's age.
(b)
(i) A
rider or endorsement added to a policy after the date of issue or at
reinstatement or renewal that reduces or eliminates a benefit or coverage in
the policy shall require a signed acceptance by the insured, unless the issuer:
(A) is effectuating a request made in writing
by the insured;
(B) is exercising a
specifically reserved right under a policy; or
(C) is required to reduce or eliminate
benefits to avoid duplication of Medicare benefits.
(ii) After the issue date of a policy or
certificate, a rider or endorsement that increases benefits or coverage with an
associated increase in premium during the policy term shall be agreed to in
writing signed by the insured, unless:
(A) the
benefits are required by the minimum standards for Medicare supplement
insurance policies; or
(B) the
increased benefit or coverage is required by law.
(iii) When a separate additional premium is
charged for benefits provided in connection with a rider or endorsement, the
premium charge shall be stated in the policy.
(c) A policy or certificate may not provide
for the payment of benefits based on standards described as "usual and
customary," "reasonable and customary," or similar words.
(d) If a policy or certificate contains a
limitation regarding a preexisting condition, the limitation shall appear as a
separate section of the policy and be labeled as "Preexisting Condition
Limitations."
(e) A policy and
certificate shall have a notice prominently printed on the first page of the
policy or certificate or attached thereto stating that the policyholder or
certificate holder has 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 is not satisfied for any
reason.
(f)
(i) An issuer of an accident and health
insurance policy or certificate that provides hospital or medical expense
coverage on an expense incurred or indemnity basis to an individual eligible
for Medicare shall provide to the applicant the Guide to Health Insurance for
People with Medicare in the form developed jointly by the NAIC and the Centers
for Medicare and Medicaid Services in a font no smaller than
12-point.
(ii) Delivery of the
guide shall be made whether or not the policy or certificate is advertised,
solicited, or issued as a Medicare supplement insurance policy or certificate
(A) Except in the case of a direct response
issuer, delivery of the guide shall be made to the applicant at application and
acknowledgement of receipt of the guide shall be obtained by the
issuer.
(B) A direct response
issuer shall deliver the guide to the applicant upon request but not later than
when the policy is delivered.
(2)
(a) As
soon as practicable, but no later than 30 days before the annual effective date
of any Medicare benefit change, an issuer shall notify each policyholder and
certificate holder of a modification it has made to a policy or certificate in
a format acceptable to the commissioner. The notice shall:
(i) include a description of the revisions to
the Medicare program and a description of each modification made to the
coverage provided under the policy or certificate; and
(ii) inform each policyholder or certificate
holder when a premium adjustment is made due to changes in Medicare.
(b) The notice of a
benefit modification and any premium adjustment shall be in outline form and in
clear and simple terms.
(c) A
notice may not contain or be accompanied by any
solicitation.
(3)
(a) An issuer shall provide an outline of
coverage to an applicant when the application is presented to the prospective
applicant and, except for direct response policies, shall obtain an
acknowledgement of receipt of the outline of coverage from the
applicant.
(b) If an outline of
coverage is provided at the time of application and a policy or certificate is
issued on a basis that requires a revision to the outline of coverage, a
substitute outline of coverage describing the policy or certificate shall
accompany the policy or certificate when it is delivered, and shall state, in
no less than 12-point bold font, immediately above the company name, "NOTICE:
Read this outline of coverage carefully. It is not identical to the outline of
coverage provided upon application and the coverage originally applied for has
not been issued."
(c)
(i) The outline of coverage shall be in no
less than 12-point font and include five parts, in the following order:
(A) a cover page;
(B) premium information;
(C) Benefit Chart of Medicare Supplement
Plans Sold on or After January 1, 2020;
(D) Outline of Coverage Disclosures;
and
(E) Standardized Plan
Description for each standardized plan offered by the issuer.
(ii) Each standardized plan shall
be shown on the cover page, and the plans offered by the issuer shall be
prominently identified.
(iii)
(A) Premium information for the offered plans
shall be shown on the cover page or immediately following the cover page, and
shall be prominently displayed.
(B)
The premium and payment mode shall be stated for each plan that is offered to
the applicant.
(C) Each possible
premium for the applicant shall be illustrated.
(4)
(a) An accident and health insurance policy
or certificate, other than a Medicare supplement insurance policy, or other
policy identified in Subsection
31A-22-620(2)(b),
issued for delivery in this state to an individual eligible for Medicare, shall
notify an insured that the policy is not a Medicare supplement insurance policy
or certificate. The notice shall either be printed or attached to the first
page of the outline of coverage delivered to an insured, or if no outline of
coverage is delivered, to the first page of the accident and health insurance
policy or certificate delivered to an insured. The notice shall be in no less
than 12-point font and shall state, "THIS (POLICY OR CERTIFICATE) IS NOT A
MEDICARE SUPPLEMENT (POLICY OR CERTIFICATE). If you are eligible for Medicare,
review the Guide to Health Insurance for People with Medicare available from
the company."
(b) An application
for an accident and health insurance policy or certificate provided to an
individual eligible for Medicare described in Subsection (3)(a) shall disclose,
using the applicable statement in Subsection R590-146-3(3), the extent to which
the policy duplicates Medicare. The disclosure statement shall be provided as a
part of, or together with, the application for the policy or
certificate.
Notes
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