Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 270 - MEDICARE SUPPLEMENT INSURANCE RULE - REVISED › Section 031-270-13 - Required disclosure provisions

Current through 2024-29, July 17, 2024
(A) General Rules.
(1) Medicare supplement policies shall
				include a renewal or continuation provision. The language or specifications of
				the provision must be consistent with the type of contract to be issued. The
				provision shall be appropriately captioned and shall appear on the first page
				of the policy.
(2) All riders or
				endorsements added to a Medicare supplement policy after date of issue or at
				reinstatement or renewal that reduce or eliminate benefits or coverage in the
				policy shall require signed acceptance by the insured, 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. 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 increase in 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 and explanation of such terms in its
				accompanying outline of coverage.
(4) If a Medicare supplement policy contains
				any limitations with respect to pre-existing conditions as permitted under
				 24-A M.R.S.A.
				§5006, such limitations must appear as a
				separate paragraph of the policy and be labeled as "Pre-existing Condition
				Limitations."
(5) Whether or not
				such policies or certificates are advertised, solicited, or issued as Medicare
				supplement policies as defined in this Rule, all insurers and other entities
				issuing accident and sickness policies or certificates which provide hospital
				or medical expense coverage on an expense incurred or indemnity basis, other
				than incidentally, shall provide a Medicare supplement buyer's guide to all
				applicants for such policies who are eligible for Medicare by reason of age.
				Except in the case of direct response insurers, the issuer shall deliver the
				buyer's guide to the applicant at the time of application and obtain written
				acknowledgment of receipt. 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. All such buyer's guides shall reflect the Medicare deductible and
				coinsurance amounts current at the time of their delivery. The buyer's guide
				shall be in the form entitled "Guide to Health Insurance for People with
				Medicare" [an edition of which is reproduced as Attachment A to this Rule],
				unless the National Association of Insurance Commissioners or the Health Care
				Financing Administration of the U.S. Department of Health and Human Services
				discontinues its endorsement of that form, or the U.S. Government Printing
				Office ceases publication of that form. In that event, the Superintendent of
				Insurance shall prescribe the form of the buyer's guide by bulletin.
(6) The terms "Medicare supplement,"
				"medigap," and words of similar import shall not be used to label, advertise,
				market, or otherwise describe any insurance policy that is not issued in
				compliance with Sections
				5,
				6,
				7, and
				9 of this Rule.