Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-598 - Appendix C-Disclosure Statements

Current through Register Vol. 50, No. 6, June 20, 2024
DISCLOSURE STATEMENTS
Instructions for Use of the Disclosure Statements for
				  Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate
				  Medicare
1.Section 1882(d) of
				the federal Social Security Act [
				42 U.S.C.
				1395 ss] prohibits the sale of a health
				insurance policy (the term policy includes certificates) to Medicare
				beneficiaries that duplicates Medicare benefits unless it will pay benefits
				without regard to a beneficiary's other health coverage and it includes the
				prescribed disclosure statement on or together with the application for the
				policy.
2. All types of health
				insurance policies that duplicate Medicare shall include one of the attached
				disclosure statements, according to the particular policy type involved, on the
				application or together with the application. The disclosure statement may not
				vary from the attached statements in terms of language or format (type size,
				type proportional spacing, bold character, line spacing, and usage of boxes
				around text).
3. State law and
				federal law prohibits insurers from selling a Medicare supplement policy to a
				person that already has a Medicare supplement policy except as a replacement
				policy.
4. Property/casualty and
				life insurance policies are not considered health insurance.
5. Disability income policies are not
				considered to provide benefits that duplicate Medicare.
6. Long-term care insurance policies that
				coordinate with Medicare and other health insurance are not considered to
				provide benefits that duplicate Medicare.
7. The federal law does not pre-empt state
				laws that are more stringent than the federal requirements.
8. The federal law does not pre-empt existing
				state form filing requirements.
9.Section 1882 of the federal Social Security
				Act was amended in Subsection (d)(3)(A) to allow for alternative disclosure
				statements. The disclosure statements already in Appendix C remain. Carriers
				may use either disclosure statement with the requisite insurance product.
				However, carriers should use either the original disclosure statements or the
				alternative disclosure statements and not use both simultaneously.
[Original disclosure statement for policies that provide
				  benefits for expenses incurred for an accidental injury only.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
This is not a Medicare Supplement Insurance
This insurance provides limited benefits, if you meet the
				  policy conditions, for hospital or medical expenses that result from accidental
				  injury. It does not pay your Medicare deductibles or coinsurance and is not a
				  substitute for Medicare supplement insurance.
This insurance duplicates Medicare benefits when it
				  pays:
· hospital or medical expenses up to the maximum stated in
				  the policy
Medicare generally pays for most or all of these
				  expenses.
Medicare pays extensive benefits for medically
				  necessary services regardless of the reason you need them. These include:
· hospitalization
· physician services
· [outpatient prescription drugs if you are enrolled in
				  Medicare Part D]
· other approved items and services
Before You Buy This Insurance
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Original disclosure statement for policies that provide
				  benefits for specified limited services.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare,
available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Original disclosure statement for policies that reimburse
				  expenses incurred for specified diseases or other specified impairments. This
				  includes expense-incurred cancer, specified disease and other types of health
				  insurance policies that limit reimbursement to named medical
				  conditions.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare,
available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Original disclosure statement for policies that pay fixed
				  dollar amounts for specified diseases or other specified impairments. This
				  includes cancer, specified disease, and other health insurance policies that
				  pay a scheduled benefit or specific payment based on diagnosis of the
				  conditions named in the policy.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Original disclosure statement for indemnity policies and
				  other policies that pay a fixed dollar amount per day, excluding long-term care
				  policies.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Original disclosure statement for policies that provide
				  benefits upon both an expense-incurred and fixed indemnity basis]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Original disclosure statement for other health insurance
				  policies not specifically identified in the preceding statements.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE
							 BENEFITS
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for policies that provide
				  benefits for expenses incurred for an accidental injury only.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for policies that provide
				  benefits for specified limited services.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for policies that reimburse
				  expenses incurred for specified diseases or other specified impairments. This
				  includes expense-incurred cancer, specified disease and other types of health
				  insurance policies that limit reimbursement to named medical
				  conditions.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for policies that pay fixed
				  dollar amounts for specified diseases or other specified impairments. This
				  includes cancer, specified disease, and other health insurance policies that
				  pay a scheduled benefit or specific payment based on diagnosis of the
				  conditions named in the policy.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for indemnity policies and
				  other policies that pay a fixed dollar amount per day, excluding long-term care
				  policies.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT]
For help in understanding your health
				  insurance, contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for policies that provide
				  benefits upon both an expense-incurred and fixed indemnity basis]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
[Alternative disclosure statement for other health insurance
				  policies not specifically identified in the preceding statements.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
Some health care services paid for by Medicare may also
				  trigger the payment of benefits from this policy.
This insurance provides limited benefits if you meet the
				  conditions listed in the policy. It does not pay your Medicare deductibles or
				  coinsurance and is not a substitute for Medicare supplement insurance.
Medicare generally pays for most or all of these
				  expenses.
Medicare pays extensive benefits for medically
				  necessary services regardless of the reason you need them. These include:
· hospitalization
· physician services
· hospice
· [outpatient prescription drugs if you are enrolled in
				  Medicare Part D]
· other approved items and services
This policy must pay benefits without regard to other
				  health benefit coverage to which you may be entitled under Medicare or other
				  insurance.
Before You Buy This Insurance
[RIGHT] Check the coverage in
all
health
				  insurance policies you already have.
[RIGHT] For more information about Medicare and Medicare
				  supplement insurance, review the
Guide to Health Insurance for People
				  with Medicare
, available from the insurance company.
[RIGHT] For help in understanding your health insurance,
				  contact your state insurance department or state [health] insurance
				  [assistance] program [SHIP].
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:224 and  42 U.S.C. 1395  et
				  seq.