Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 12 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 16-12-8 - Required disclosure provisions

Current through June, 2024
(a) General rules
			 are as follows. Medicare supplement policies and certificates shall include a
			 renewal or continuation provision. The language or specifications of the
			 provision must be consistent with the type of contract issued. The provision
			 shall be appropriately captioned, shall appear on the first page of the policy
			 or certificate, 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.
(b) 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 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.
(c) 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.
(d) If a Medicare
			 supplement policy or certificate contains any limitations with respect to
			 preexisting conditions, the limitations shall appear as a separate paragraph of
			 the policy and be labeled as "Preexisting Condition Limitations."
(e) 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 certificate holder shall have the right to return the policy or
			 certificate within thirty 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.
(f)
(1) Issuers of accident and sickness policies
			 or certificates which provide hospital or medical expense coverage on an
			 expense incurred or indemnity basis to a person(s) 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 & Medicaid Services
			 and in a type size no smaller than twelve 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 regulation. 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.
(2) For the purposes of
			 this section, "form" means the language, format, type size, type proportional
			 spacing, bold character, and line spacing.