(1) Medicare supplement policies and
certificates shall include a renewal or continuation provision. The language or
specifications of the provision shall be consistent with the type of contract
issued. The provision shall be appropriately captioned and shall appear on the
first page of the policy, and shall include any reservation by the issuer of
the right to change premiums and any automatic renewal premium increases based
on the policyholder's age.
Except for riders or endorsements by which the issuer 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 a
signed acceptance by the insured. After the date of policy or certificate
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, the premium charge
shall be set forth in the policy.
(3) Medicare supplement policies or
certificates shall not provide for the payment of benefits based on standards
described as "usual and customary," "reasonable and customary" or words of
(4) If a Medicare
supplement policy or certificate contains any limitations with respect to
preexisting conditions, such limitations shall appear as a separate section of
the policy and be labeled as "Preexisting Condition Limitations."
(5) Medicare supplement policies and
certificates shall have a notice prominently printed on the first page of the
policy or certificate or attached thereto stating in substance 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.
(a) Issuers of accident and sickness policies
or certificates which provide hospital or medical expense coverage on an
expense incurred or indemnity basis to persons eligible for Medicare shall
provide to those applicants a Guide to Health Insurance for People with
Medicare in the form developed jointly by the National Association of Insurance
Commissioners and the Centers for Medicare and Medicaid Services, CMS, in a
type size no smaller than 12 point type. Delivery of the Guide shall be made
whether or not the policies or certificates are advertised, solicited or issued
as Medicare supplement policies or certificates as defined in this rule. Except
in the case of direct response issuers, delivery of the Guide shall be made to
the applicant at the time of application and acknowledgment of receipt of the
Guide shall be obtained by the issuer. Direct response issuers shall deliver
the Guide to the applicant upon request but not later than at the time the
policy is delivered.
(b) For the
purposes of this section, "form" means the language, format, type size, type
proportional spacing, bold character, and line spacing.
As soon as practicable, but no later than
30 days prior to the annual effective date of any Medicare benefit changes, an
issuer shall notify its policyholders and certificate holders of modifications
it has made to Medicare supplement insurance policies or certificates in a
format acceptable to the commissioner. The notice 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 policy or certificate; and
(b) inform each policyholder or
certificateholder as to when any premium adjustment is to be made due to
changes in Medicare.
The notice of benefit modifications and any premium adjustments shall be in
outline form and in clear and simple terms so as to facilitate
(3) The notices
shall not contain or be accompanied by any solicitation.
MMA Notice Requirements.
Issuers shall comply with any notice requirements of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Outline of Coverage
Requirements for Medicare Supplement Policies.
(1) Issuers shall provide an outline of
coverage to all applicants at the time application is presented to the
prospective applicant and, except for direct response policies, shall obtain an
acknowledgment of receipt of the outline from the applicant.
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 the policy or certificate when it is delivered and contain the
following statement, in no less than 12 point type, immediately above the
"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."
(3) The outline of coverage provided to
applicants pursuant to this section consists of four parts: a cover page,
premium information, disclosure pages, and charts displaying the features of
each benefit plan offered by the issuer. The outline of coverage shall be in
the language and format prescribed below in no less than 12-point type. All
plans shall be shown on the cover page, and the plans that are offered by the
issuer shall be prominently identified. Premium information for plans that are
offered shall be shown on the cover page or immediately following the cover
page and shall be prominently displayed. The premium and mode shall be stated
for all plans that are offered to the prospective applicant. All possible
premiums for the prospective applicant shall be illustrated.
(4) The Outline of Medicare Supplement
Coverage, from the National Association of Insurance Commissioners, dated 1998,
or the Benefit Chart of Medicare Supplement Plans Sold on or After June 1,
2020, adopted August 2016, as incorporated by reference herein, is available
for public inspection at the Insurance Department.
Notice Regarding Policies or Certificates
Which Are Not Medicare Supplement Policies.
Any accident and sickness insurance
policy or certificate, other than a Medicare supplement policy; a policy issued
pursuant to a contract under Section 1876 of the Federal Social Security Act,
et seq.; a disability income policy; or
other policy identified in Subsection 3B of this rule; issued for delivery in
this state to persons eligible for Medicare, shall notify insureds under the
policy that the policy is not a Medicare supplement policy or certificate. The
notice shall either be printed or attached to the first page of the outline of
coverage delivered to insureds under the policy, or if no outline of coverage
is delivered, to the first page of the policy, or certificate delivered to
insureds. The notice shall be in no less than 12-point type and shall contain
the following language:
"THIS (POLICY OR CERTIFICATE) IS NOT A MEDICARE SUPPLEMENT
(POLICY OR CONTRACT). If you are eligible for Medicare, review the Guide to
Health Insurance for People with Medicare available from the company."
(2) Applications provided to
persons eligible for Medicare for the health insurance policies or certificates
described in Subsection D(1) shall disclose, using the applicable statement in
Subsection 25.E., 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.