Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.490 - Required disclosure provisions

Current through May 31, 2024
(a) Medicare
				  supplement policies and certificates must include a renewal or continuation
				  provision The language or specifications of the provisions must be consistent
				  with the type of contract issued The provisions must be appropriately
				  captioned, must appear on the first page of the policy, and must 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 fulfills 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 the date of
				  issue or at reinstatement or renewal that reduce or eliminate benefits or
				  coverage in the policy must require a signed acceptance by the insured. After
				  the date of a policy or certificate issue, a rider or an endorsement that
				  increases benefits or coverage with a concomitant increase in premium during
				  the policy term must be agreed to in writing and signed by the insured, unless
				  the benefits are required by the minimum standards for Medicare supplement
				  policies or if the increased benefits or coverage are required by law. If a
				  separate additional premium is charged for benefits provided in connection with
				  a rider or an endorsement, the premium charge must be set out in the
				  policy.
(c) A Medicare supplement
				  policy or certificate may 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 a limitation with respect to
				  a preexisting condition, the limitation must appear as a separate paragraph of
				  the policy and be labeled "preexisting condition limitation."
(e) A Medicare supplement policy or
				  certificate must have a notice prominently printed on the first page of the
				  policy or certificate or attached to it stating in substance that the
				  policyholder or certificate holder shall have the right to return the policy or
				  certificate within 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) An
				  issuer of accident and sickness policies or certificates that provide hospital
				  or medical expense coverage on an expense incurred or indemnity basis to a
				  person eligible for Medicare must provide to the applicant 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 and Medicaid Services and in a type size no smaller than 12-point
				  type. Delivery of the
Guide
must be made regardless of whether
				  the policies or certificates are advertised, solicited, or issued as Medicare
				  supplement policies or certificates under
				  3 AAC 28.410-3 AAC 28.510. Except for a direct response issuer, delivery
				  of the
Guide
must be made to the applicant at the time of
				  application and acknowledgment of receipt of the
Guide
must be
				  obtained by the issuer. A direct response issuer shall deliver the
Guide
to the applicant upon request, but not later than at the
				  time the policy is delivered.
(g)
				  As soon as practicable, but not later than 30 days before the annual effective
				  date of a Medicare benefit change, an issuer shall notify its policyholders and
				  certificate holders of modifications that the issuer has made to Medicare
				  supplement insurance policies or certificates in a format acceptable to the
				  director. The notice must
(1) include a
				  description of revisions to the Medicare program and a description of each
				  modification made to the coverage provided under the Medicare supplement policy
				  or certificate; and
(2) inform the
				  policyholder or certificate holder when a premium adjustment is to be made due
				  to changes in Medicare.