Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 37 - Medicare Supplement Insurance › Rule 191-37.28 - Required Disclosure Provisions

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
General rules.
a. A Medicare supplement policy or
				certificate shall include renewal or continuation provisions. The language or
				specifications of such provisions shall be consistent with the type of Medicare
				supplement policy issued. Such provisions shall be appropriately captioned and
				shall appear on the first page of the Medicare supplement policy or
				certificate, and shall include any reservations by the issuer of the right to
				change premiums and any automatic renewal premium increases based on the
				covered individual's age.
b. Except
				for a rider or an endorsement by which the issuer effectuates a request made in
				writing by the covered individual, exercises a specifically reserved right
				under a Medicare supplement policy or certificate, or is required to reduce or
				eliminate benefits to avoid duplication of Medicare benefits, any rider or
				endorsement added to a Medicare supplement policy or certificate after the date
				the policy or certificate is issued, or at reinstatement or renewal, which
				reduces or eliminates benefits or coverage in the policy or certificate shall
				require a signed acceptance by the covered individual. After the date of issue
				of a Medicare supplement policy or certificate, any rider or endorsement which
				increases benefits or coverage with a concomitant increase in premium during
				the policy term shall be agreed to in writing signed by the covered individual,
				unless the benefits are required by the minimum standards for Medicare
				supplement policies or certificates, or if the increased benefits or coverage
				is required by law. Where a separate additional premium is charged for benefits
				provided in connection with a rider or endorsement, such premium charge shall
				be set forth in the Medicare supplement policy or certificate.
c. 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.
d. 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 Medicare supplement policy or certificate and be labeled as "Preexisting
				Condition Limitations."
e. A
				Medicare supplement policy or certificate shall have a notice prominently
				printed on the first page of the policy or certificate, or attached thereto,
				stating in substance that the covered individual shall have the right to return
				the Medicare supplement policy or certificate within 30 days of its delivery
				and to have the premium refunded if, after examination of the Medicare
				supplement policy or certificate, the covered individual is not satisfied for
				any reason.
f. An issuer of an
				accident or sickness policy or certificate which provides hospital or medical
				expense coverage on an expense-incurred or indemnity basis to an individual
				eligible for Medicare shall provide to any applicant for such policy or
				certificate the most recent version of
Choosing a Medigap Policy: Guide
				to Health Insurance for People with Medicare,
issued by Centers for
				Medicare and Medicaid Services ("guide"), developed jointly by the National
				Association of Insurance Commissioners and CMS, using the same language,
				format, type size (no less than 12 point), type-proportional spacing, bold
				characters and line spacing. Delivery of the guide shall be made whether or not
				such policy or certificate was advertised, solicited or issued as a Medicare
				supplement policy or certificate as defined in this chapter. Except in the case
				of a direct response issuer, 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 issuer. A direct response issuer shall deliver the
				guide to the applicant upon request but not later than at the time the Medicare
				supplement policy is delivered.