Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.13 - Required Disclosure Provisions

Current through Register 1525, July 5, 2024
(1)
General Rules
.
(a)
			 Each Medicare Supplement Insurance Policy covered by
			 211 CMR 71.00 shall have an
			 outline of coverage. The outline of coverage is prescribed in 211 CMR 71.13(2).
			 This outline of coverage shall not be part of a Policy.
(b) Issuers shall provide an outline of
			 coverage to all Applicants at the time the application is presented to the
			 prospective Applicant and, except for direct response Policies, shall obtain an
			 acknowledgment of receipt of the outline of coverage from the
			 Applicant.
(c) If the Policy issued
			 is different from the Policy for which an application was made and for which an
			 outline of coverage was previously issued, a revised outline of coverage,
			 properly describing the Policy, shall be attached to the Policy. Such revised
			 outline of coverage shall contain the following statement in no less than
			 12-point type, immediately above the company name:
"NOTICE: Read this outline of coverage summary carefully. It is
				not identical to the summary provided upon application and the coverage
				originally applied for has not been issued."
(d) Except for riders or endorsements by
			 which the Issuer effectuates a request made in writing by the Insured,
			 exercises a specifically reserved right under a Medicare Supplement Insurance
			 Policy, or is required to reduce or eliminate benefits to avoid duplication of
			 Medicare benefits, all riders or endorsements added to a Medicare Supplement
			 Insurance 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 issue, any rider or
			 endorsement that increases benefits or coverage with a concomitant increase in
			 premium during the Policy term shall be agreed to in writing signed by the
			 Insured, unless the benefits are required by the minimum standards for Medicare
			 Supplement Insurance Policies, or if the increased benefits or coverage is
			 required by 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.
(e) Each
			 Policy shall have a notice prominently printed on the first page of the Policy
			 or attached thereto stating in substance that the Policyholder shall have the
			 right to return the Policy within 30 days of its delivery and to have the
			 premium refunded if, after examination of the Policy, the insured person is not
			 satisfied for any reason.
(f) Each
			 Policy shall not provide for the payment of benefits based on standards
			 described as usual and customary", "reasonable and customary", or words of
			 similar import.
(g) Each Policy
			 shall have a specification page and shall provide the following information:
1. The Policy number;
2. The name of the Insured;
3. The effective date, assuming the premium
			 for the Policy has been paid on or before that date; and
4. A listing of the premium or premiums
			 payable and the periods to which they apply.
(h) No misleading Policy names shall be used.
			 A carrier's Policy name shall not misrepresent the extent of benefits actually
			 provided. Carriers shall not use the name "Medicare Supplement", "Medigap" or
			 similar terms except to describe a Policy that complies with
			 211 CMR 71.00.
(i) All outlines of coverage for Medicare
			 Supplement Insurance must be filed with the Division of Insurance pursuant to
			 211
			 CMR 71.12(8)(l).