New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 25 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 13.10.25.23 - REQUIRED DISCLOSURE PROVISIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
General rules.
(1)
Renewal or continuation.
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)
Riders or
				endorsements.
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)
Payment standards.
Medicare
				Supplement policies or certificates issued or delivered after July 1, 1992
				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)
Disclosure of
				preexisting condition limitations.
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)
Return and refund period.
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 certificate holder shall
				have the right to return the policy or certificate within 30 days of its
				delivery and to have the premium refunded within 30 days after its return if,
				after examination of the policy or certificate, the insured person is not
				satisfied for any reason.
(6)
Delivery of guide.
(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 NAIC and Center for Medicare and Medicaid Services (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.