New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 58 - Minimum Standards For Form, Content And Sale Of Medicare Supplement And Medicare Select Insurance, Including Standards Of Full And Fair Disclosure › Section 58.5 - Required disclosure statement for policies and certificates meeting definition of sections 52.11 and 52.14 of this title issued with an effective date for coverage on or after june 1, 2010

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  The disclosure statement required by an issuer of policies and certif- icates
				  of Medicare supplement insurance meeting the standards of sections
				  52.11
				  and
				  52.14 
				  of this Title and sections
				  58.1
				  and
				  58.4 
				  of thi s Part shall consist of four parts: a cover page, premium information,
				  disclosure pages, and charts displaying the features of each benefit plan
				  offered by the issuer. The disclosure statement shall be in the language and
				  format prescribed below in not less than 12-point type. All benefit plans "A"
				  thr ough "D", "F", "F+", "G", "G+", and "K" through "N" shall be shown on the
				  cover page, and the plan(s) that are offered by the issuer shall be p
				  rominently identified. Premium information for plans that are offered shall be
				  shown on the cover page or immediately following the cover page and shall be
				  prominently displayed. The premium and mode shall be stated for all plans that
				  are offered to the prospective applicant. All possible premiums for the
				  prospective applicant shall be illustrated.
(b) No individual accident and health
				  insurance policy shall be delivered or issued for delivery in this State,
				  unless the appropriate disclosure form in this section is provided to the
				  applicant at the time that the application is presented to the prospective
				  applicant and, except for direct response insurance, written acknowledgment of
				  receipt of the requisite disclosure statement shall be obtained from the
				  applicant by the issuer.
(c) Every
				  issuer of a certificate of Medicare supplement insurance delivered or issued
				  for delivery in this State shall provide the applicant for the coverage with a
				  disclosure statement in the form prescribed in this section except that all
				  references to "policy" shall be replaced with "certificate," where appropriate.
				  The disclosure statement must be provided at the time that the application is
				  presented to the prospective applicant and, except in the case of direct
				  response insurance, written acknowledgment of receipt of the requisite
				  disclosure statement shall be obtained from the applicant by the
				  insurer.
(d) If the Medicare
				  supplement insurance policy or certificate is issued on a basis that would
				  require revision of the disclosure statement, then a substitute disclosure
				  statement properly describing the policy or certificate shall accompany such
				  policy or certificate when it is delivered and contain the following statement,
				  in not less than 12-point type, immediately above the company name:
"NOTICE: Read this disclosure statement (outline of
					 coverage) carefully. It is not identical to the disclosure statement (outline
					 of coverage) provided upon application and the coverage originally applied for
					 has not been issued."
(e)
				  Attached is an appendix (Appendix 12B, infra) containing the items that shall
				  be included in the disclosure statement in the order prescribed
				  therein.