Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 40.00 - Marketing of insured health plans › Section 40.15 - Required Disclosure for Medicare-eligible Policyholders and Certificateholders

Current through Register 1525, July 5, 2024
(1)
Guide to Health Insurance for People with
			 Medicare
. Insurers 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 the Centers for Medicare & Medicaid Services
			 and in a type size no smaller than 12 point type. The Guide shall also include
			 an attachment concerning the Massachusetts Medicare Supplement Insurance
			 Program in a form prescribed by the Commissioner 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
			 211 CMR 71.00:
Medicare Supplement Insurance to Facilitate the Implementation of
			 M.G.L. c. 176K and Section 1882 of the Federal Social Security Act
.
			 Except in the case of direct response carriers, 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 insurer. Direct response carriers shall
			 deliver the Guide to the applicant upon request but not later than at the time
			 the Policy is delivered.
For the purposes of 211 CMR 40.15(1), "form" means the
				language, format, type size, type proportional spacing, bold character and line
				spacing.
(2)
Required Notice for Non-Medicare Supplement Policies
.
			 Any accident and sickness insurance or long-term care insurance policy or
			 certificate, other than a Medicare Supplement policy, a policy issued pursuant
			 to a contract under Section 1876 of the federal Social Security Act (
			 42 U.S.C.
			 §1395,
et seq
.);
			 disability income policy or other policy identified in
			 211 CMR
			 71.02(2), issued for
			 delivery to persons eligible for Medicare shall notify insureds under the
			 policy that the policy is not a Medicare Supplement policy or certificate. The
			 notice shall either be printed or attached to the first page of the outline of
			 coverage delivered to insureds under the policy, or if no outline of coverage
			 is delivered, to the first page of the policy, or certificate delivered to
			 insureds. The notice shall be in no less than 12 point type and shall contain
			 the following language:
"THIS [POLICY OR CERTIFICATE] IS NOT A MEDICARE SUPPLEMENT
				[POLICY OR CONTRACT]. If you are eligible for Medicare, review the Guide to
				Health Insurance for People with Medicare available from the company."
(3) Applications provided to
			 persons eligible for Medicare for the health insurance or long-term care
			 insurance policies or certificates described in
			 211 CMR
			 71.13(2)(d)5.a. shall
			 disclose, using the applicable statement in
			 211 CMR
			 71.100:
Appendix H
, the
			 extent to which the policy duplicates Medicare. The disclosure statement shall
			 be provided as a part of, or together with, the application for the policy or
			 certificate.