California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.6 - Medicare Supplement Coverage › Section 2220.59 - Notice of New or Innovative Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For
				  the purposes of this section, "issuer" has the same meaning as in Insurance
				  Code section
				  10192.4(i).
(b) An issuer that offers one or more
				  Medicare supplement plans with a new or innovative benefit as described in
				  Insurance Code section
				  10192.91(f)(1)
				  (each such benefit a "new or innovative benefit" hereinafter) shall provide the
				  Notice of New or Innovative Benefits described in subdivision (g) of this
				  Section 2220.59 together with the annual notice required by Insurance Code
				  section
				  10192.11(h)(1),
				  whenever the issuer provides such annual notice to a current policyholder or
				  certificate holder of any Medicare supplement plan offered by the issuer. The
				  issuer shall provide a separate Notice of New or Innovative Benefits for each
				  plan offered by the issuer that has a new or innovative benefit.
(c) An issuer described in subdivision (b) of
				  this section shall provide the Notice of New or Innovative Benefits described
				  in subdivision (g) of this section together with the information required by
				  Insurance Code section
				  10192.17(j),
				  whenever the issuer provides such information to a prospective policyholder or
				  certificate holder of any Medicare supplement plan offered by the issuer. The
				  issuer shall provide a separate Notice of New or Innovative Benefits for each
				  plan offered by the issuer that has a new or innovative benefit.
(d) In the Notice of New or Innovative
				  Benefits, the issuer shall disclose, using the format specified in the form of
				  notice shown in subdivision (g) of this section, the issuer's name, the name of
				  the plan described in the Notice of New or Innovative Benefits, and the
				  issuer's contact information. At a minimum, the issuer's contact information
				  shall include the issuer's mailing address and telephone number so that a
				  current or prospective policyholder or certificate holder can request
				  additional information about the issuer's Medicare supplement plans with new or
				  innovative benefits.
(e) In the
				  Notice of New or Innovative Benefits, the issuer shall disclose, in the format
				  specified in the form of notice shown in subdivision (g) of this section, the
				  total annual premium for the new or innovative benefits. If the premium for the
				  new or innovative benefits is subject to rating factors, the issuer shall
				  attach to the Notice of New or Innovative Benefits a rate sheet listing the
				  amount of premium for the new or innovative benefits.
(f) In the table within the Notice of New or
				  Innovative Benefits, the issuer shall list each new or innovative benefit, a
				  detailed description of each new or innovative benefit to the extent it is
				  necessary to accurately describe the benefit, any limitations that apply to
				  each new or innovative benefit, and the policyholder's or certificate holder's
				  out-of-pocket cost, other than the annual premium, for each new or innovative
				  benefit. The issuer may remove rows from, or add rows to, the table shown in
				  subdivision (g) of this section, ensuring that the information described in
				  this subdivision (f) is included for all covered new or innovative
				  benefits.
(g) The Notice of New or
				  Innovative Benefits shall be in the following form; if the plan in question
				  does not use a network of providers, the issuer shall omit the "YOUR
				  OUT-OF-POCKET COSTS (In-Network Provider)" column, and shall omit
				  "(Out-of-Network Provider)" from the heading of the remaining column,
				  designated for out-of-pocket costs:
Notice of New or Innovative Benefits
The purpose of this form is to notify consumers of
					 the availability of a Medicare supplement plan offered for sale by [INSERT
					 ISSUER NAME] that includes new or innovative benefits, in addition to the
					 standardized coverage offered by the plan.
For additional information, please contact [INSERT
					 ISSUER CONTACT INFORMATION].
New or innovative benefits added to Medicare
					 supplement plan [INSERT PLAN NAME].
Total annual premium for new or innovative benefits
					 only: $[XX.XX] [see attached rate sheet].
NEW OR INNOVATIVE BENEFITS
YOUR OUT-OF-POCKET COSTS (In-Network
							 Provider)
YOUR OUT-OF-POCKET COSTS (Out-of-Network
							 Provider)
[New or innovative benefit, detailed description, and
							 any limitations]
[Out-of-pocket cost]
[Out-of-pocket cost]
[New or innovative benefit, detailed description, and
							 any limitations]
[Out-of-pocket cost]
[Out-of-pocket cost]
[New or innovative benefit, detailed description, and
							 any limitations]
[Out-of-pocket cost]
[Out-of-pocket cost]
Note: Authority cited: Section 10192.91, Insurance Code.
						Reference: Section 10192.91, Insurance Code.