Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-071 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS REGULATION › Section 482-1-071-.17 - Required Disclosure Provisions

Current through Register Vol. 42, No. 9, June 28, 2024
A. General Rules.
(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.
(2)
			 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
			 similar import.
(4) If a Medicare
			 supplement policy or certificate 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."
(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 thirty (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.
(6)
(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 CMS and 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 chapter. Except in the
			 case of direct response issuers, delivery of the
Guide
shall
			 be made to the applicant at the time of application and acknowledgement 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 rule, "form"
			 means the language, format, type size, type proportional spacing, bold
			 character, and line spacing.