Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.014 - Required Disclosure Provisions

Current through Reg. 50, No. 138; July 16, 2024
(1)
				General Rules.
(a) 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.
(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 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.
(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,
				such 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 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.
(f) Any issuer delivering or issuing for
				delivery a Medicare supplement policy, subject to this part, shall give the
				policyholder or certificateholder at least 45 days advance notice of a change
				in rates. Such notice shall be mailed to the policyholder's last address as
				shown by the records of the issuer.
(g) 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 Centers for Medicare and Medicaid Services (CMS)
				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. For the purposes of
				this section, "form" means the language, format, type size, type proportional
				spacing, bold character, and line spacing.