Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-10 - Required disclosure provisions

Current through July 10, 2024
(a)
General
			 Rules.
(1) Medicare supplement policies
			 shall include a renewal or continuation provision. The language or
			 specifications of such provision must be consistent with the type of contract
			 issued. Such provision shall be appropriately captioned, and shall appear on
			 the first page of the policy.
(2)
			 Except for riders or endorsements by which the insurer 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 issue, any rider or
			 endorsement which increases benefits or coverage with a concomitant increase in
			 premium during the policy term must be agreed to in writing signed by the
			 insured, unless the benefits are required by the minimum standards for Medicare
			 supplement insurance 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) A
			 Medicare supplement policy which provides for the payment of benefits based on
			 standards described as "usual and customary," "reasonable and customary" or
			 words of similar import shall include a definition of such terms and an
			 explanation of such terms in its accompanying outline of coverage.
(4) If a Medicare supplement policy contains
			 any limitations with respect to preexisting conditions, such limitations must
			 appear as a separate paragraph of the policy and be labeled as "Preexisting
			 Condition Limitations."
(5)
			 Medicare supplement policies or certificates shall have a notice prominently
			 printed on the first page of the policy or certificate or attached thereto
			 stating in substance that the policy 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 in a reasonably prompt manner if, after
			 examination of the policy or certificate, the insured person is not satisfied
			 for any reason.
(6) Insurers
			 issuing accident and sickness policies, certificates or subscriber contracts
			 which provide hospital or medical expense coverage on an expense incurred or
			 indemnity basis to a person(s) eligible for Medicare by reason of age shall
			 provide to all applicants a Medicare supplement Buyer's Guide in the form
			 developed jointly by the National Association of Insurance Commissioners and
			 the Health Care Financing Administration. Delivery of the Buyer's Guide shall
			 be made whether or not such policies, certificates or subscriber contracts are
			 advertised, solicited or issued as Medicare supplement policies as defined in
			 this regulation. Except in the case of direct response insurers, delivery of
			 the Buyer's Guide shall be made to the applicant at the time of application and
			 acknowledgement of receipt of the Buyer's Guide shall be obtained by the
			 insurer. Direct response insurers shall deliver the Buyer's Guide to the
			 applicant upon request but not later than at the time the policy is
			 delivered.