Idaho Administrative Code › Title IDAPA 18 - Insurance, Department of › Rule 18.04.10 - MEDICARE SUPPLEMENT INSURANCE STANDARDS › Section 18.04.10.066 - DISCLOSURE PROVISIONS

Current through August 31, 2023
01.
General
			 Rules
. (3-31-22)
a. Medicare supplement
			 policies and certificates includes a renewal or continuation provision. The
			 language or specifications of the provision is consistent with the type of
			 contract issued. The provision is appropriately captioned and appears on the
			 first page of the policy, and includes any reservation by the issuer of the
			 right to change premiums. (3-31-22)
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 needed 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 requires 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 is agreed to in writing and signed by the insured, unless the benefits are
			 prescribed by the minimum standards for Medicare supplement policies, or if the
			 increased benefits or coverage is prescribed by law. Where a separate
			 additional premium is charged for benefits provided in connection with riders
			 or endorsements, the premium charge is set forth in the policy.
			 (3-31-22)
c. Medicare supplement
			 policies or certificates do not provide for the payment of benefits based on
			 standards described as "usual and customary," "reasonable and customary," or
			 words of similar import. (3-31-22)
d. If a Medicare supplement policy or
			 certificate contains any limitations with respect to preexisting conditions,
			 such limitations appear as a separate paragraph of the policy and be labeled as
			 "Preexisting Condition Limitations." (3-31-22)
e. Medicare supplement policies and
			 certificates 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 has 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. (3-31-22)
f.
			 Issuers of accident and sickness policies or certificates that provide hospital
			 or medical expense coverage on an expense incurred or indemnity basis to
			 persons eligible for Medicare provide to those applicants a "Guide to Health
			 Insurance for People with Medicare" in the form developed jointly by the
			 National Association of Insurance Commissions and the Centers for Medicare
			 & Medicaid Services and in a type size no smaller than twelve (12) point
			 type. Delivery of the Guide is made whether or not the policies or certificates
			 are advertised, solicited or issued as Medicare supplement policies or
			 certificates. Except in the case of direct response issuers, delivery of the
			 Guide will be made to the applicant at the time of application and
			 acknowledgment of receipt of the Guide is obtained by the issuer. Direct
			 response issuers deliver the Guide to the applicant upon request but not later
			 than at the time the policy is delivered. (3-31-22)
g. For the purposes of Section
			 066, "form" means the language,
			 format, type size, type proportional spacing, bold character, and line spacing.
			 (3-31-22)