Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.509 - REQUIRED DISCLOSURE PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) Medicare supplement
				policies and certificates must 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 must be appropriately captioned, must appear on
				the first page of the policy, and must include any reservation by the issuer of the
				right to change premiums and any automatic renewal premium increases based on the
				policyholder's age.
(2) Except for
				riders or endorsements by which the issuer effectuates a request made in writing by
				the insured or 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 must require a signed acceptance by the insured.
				After the date of policy or certificate issue, any rider or endorsement that
				increases benefits or coverage with a concomitant increase in premium during the
				policy term must be agreed to in writing and signed by the insured, unless the
				increased benefits or coverage are required by the minimum standards for Medicare
				supplement policies, or if the increased benefits or coverage is required by law. If
				a separate additional premium is charged for benefits provided in connection with
				riders or endorsements, the premium charge must be set forth in the
				policy.
(3) Medicare supplement policies
				or certificates must 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, the limitations must appear as a separate paragraph of the policy and be
				labeled as "Preexisting Condition Limitations".
(5) Medicare supplement policies and certificates
				must have notices prominently printed on the first page of the policy or certificate
				or attached thereto stating in substance that the policyholder or certificateholder
				shall have the right to return the policy or certificate within 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) Issuers of accident and sickness policies or
				certificates or subscriber contracts that provide hospital or medical expense
				coverage on an expense incurred or indemnity basis to persons eligible for Medicare
				must provide to such applicants a Medicare supplement "buyer's guide". This may be
				the pamphlet entitled "Guide to Health Insurance for People with Medicare,"
				developed jointly by the national association of insurance commissioners and the
				center for Medicaid and Medicare services (CMS) of the U.S. Department of Health and
				Human Services, or any reproduction or official revision of that pamphlet in a type
				size no smaller than 12 point type. The "buyer's guide" must conform to the
				language, format, type size, type proportional spacing, bold character, and line
				spaces as specified in Appendix C of the NAIC Model Regulation (see ARM 6.6.526).
(a) Delivery of the "buyer's guide" must 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 "buyer's guide" must be made to the
				applicant at the time of application and acknowledgment of receipt of the "buyer's
				guide" must be obtained by the issuer. Direct response issuers must deliver the
				"buyer's guide" to the applicant upon request but not later than at the time the
				policy is delivered.