Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 275 - Medicare Supplement Insurance › Section 031-275-17 - Required Disclosure Provisions

Current through 2024-29, July 17, 2024
A. General Rules.
(1) Medicare supplement policies and
				certificates shall include a renewal or continuation provision. The language or
				specifications of the 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.
(2) Except for riders and 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 must be agreed to in writing signed by the
				insured, unless the increase is required by the minimum standards for Medicare
				supplement policies or other applicable law. Where a separate additional
				premium is charged for benefits provided in connection with riders or
				endorsements, the premium charge shall be set forth in the policy.
(3) 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.
(4) 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."
(5) 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 certificate holder 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.
(6)
a.
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 the Centers for Medicare & Medicaid Services
				  (CMS) and in a type size no smaller than 12 point type. Delivery of the
Guide to Health Insurance for People with Medicare
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 Rule.
				  Except in the case of direct response issuers, delivery of the
Guide
to Health Insurance for People with Medicare shall be
				  made to the applicant at the time of application and acknowledgment of receipt
				  of the
Guide to Health Insurance for People with Medicare
shall be obtained by the issuer. Direct response issuers shall deliver the
Guide to Health Insurance for People with Medicare
to the
				  applicant upon request but not later than at the time the policy is
				  delivered.
b. For the
				purposes of this section, "form" means the language, format, type size, type
				proportional spacing, bold character, and line spacing.