Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-13 - Required disclosure provisions

Current through July 10, 2024
(a)
General
			 Rules
.
(1) Medicare supplement policies
			 and certificates shall include a renewal or continuation provision. The
			 language or specifications of such provision shall be consistent with the type
			 of contract issued. Such 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, such 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 Centers for Medicare and
			 Medicaid Services and in a type size no smaller than 12 point type. Delivery of
			 the Guide shall be made whether or not such 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 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.