Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-560 - Required Disclosure Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. General Rules
1. Medicare supplement policies and
				certificates shall include a renewal or continuation provision. The language or
				specifications of the provision shall be consistent with the type of contract
				issued. The provision shall be appropriately captioned and shall appear on the
				first page of the policy, and shall 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, 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 shall require a
				signed acceptance by the insured. After the date of policy or certificate
				issue, 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 insured, unless the benefits are required by the minimum
				standards for Medicare supplement 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.
3. 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.
4. 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 policy and be labeled as "Preexisting Condition Limitations."
5. Medicare supplement policies and
				certificates shall have a notice prominently printed on the first page of the
				policy or certificate 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.
a. Issuers of accident and sickness policies
				or certificates which provide hospital or medical expense coverage on an
				expense incurred or indemnity basis to persons eligible for Medicare shall
				provide to those applicants a
Guide to Health Insurance for People with
				Medicare
in the form developed jointly by the National Association of
				Insurance Commissioners and CMS and in a type size no smaller than 12 point
				type. Delivery of the
Guide
shall be made whether or not the
				policies or certificates are advertised, solicited, or issued as Medicare
				supplement policies or certificates, as defined in this regulation. Except in
				the case of direct response issuers, delivery of the
Guide
shall be made to the applicant at the time of application, and acknowledgement
				of receipt of the
Guide
shall be obtained by the issuer.
				Direct response issuers shall deliver the
Guide
to the
				applicant upon request but not later than at the time the policy is
				delivered.
b. For the purposes of
				this Section,
form
means the language, format, type size, type
				proportional spacing, bold character, and line spacing.