Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 13 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 365:10-5-134 - Required disclosure provisions

Current through Vol. 41, No. 20,
				  July 1, 2024
(a)
General rules.
(1) Medicare
				  supplement policies and certificates shall include a renewal or continuation
				  provision. The language or specifications of such provision shall be consistent
				  with the type of contract issued. Such 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, such 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 or attached thereto stating in substance that the
				  policyholder or certificateholder shall have the right to return the policy or
				  certificate within thirty (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) If the issuer does not return any
				  premiums or moneys paid therefor within thirty (30) days from the date of
				  cancellation, the issuer shall pay interest on the proceeds which shall be the
				  same rate of interest as the average United States Treasury Bill rate of the
				  preceding calendar year as certified to the State Insurance Commissioner by the
				  State Treasurer on the first regular business day in January of each year, plus
				  two percentage points which shall accrue from the date of cancellation until
				  the premiums or moneys are returned. In such event, the policy shall be deemed
				  to have been cancelled on the date the policy was placed in the United States
				  mails in a properly addressed, postage paid envelope; or, if not so posted, on
				  the date of delivery of such policy to the issuer.
(7) Issuers of accident and health policies
				  or certificates which provide hospital or medical expense coverage on an
				  expense incurred or indemnity basis, to a person(s) 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 the CMS and in a type size no smaller than 12 point type.
				  Delivery of the Guide shall be made whether or not such policies or
				  certificates are advertised, solicited or issued as Medicare supplement
				  policies or certificates as defined in this Part. 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.
				  For purposes of this section, "form" means the language, format, type size,
				  type proportional spacing, bold character, and line spacing.