North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-14 - Required disclosure provisions

Current through Supplement No. 393, July, 2024
1.
General rules.
a. Medicare
				supplement policies and certificates must include a renewal or continuation
				provision. The language or specifications of the provision must be consistent
				with the type of contract issued. Such provision must be appropriately
				captioned and must appear on the first page of the policy, and must include any
				reservation by the issuer of the right to change premiums and any automatic
				renewal premium increases based on the policyholder's age.
b. 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 must 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 must 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. When a
				separate additional premium is charged for benefits provided in connection with
				riders or endorsements, the premium charge must be set forth in the
				policy.
c. Medicare supplement
				policies or certificates may not provide for the payment of benefits based on
				standards described as "usual and customary", "reasonable and customary", or
				words of similar import.
d. If a
				Medicare supplement policy or certificate contains any limitations with respect
				to preexisting conditions, such limitations must appear as a separate paragraph
				of the policy and be labeled as "preexisting condition limitations".
e. Medicare supplement policies and
				certificates must 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 has the right to return the policy or
				certificate within thirty 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.
f.
(1) 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 must
				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 centers for Medicare and Medicaid services and in a type
				size no smaller than twelve-point type. Delivery of the guide must be made
				whether or not such 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 must be made to the applicant at the time of application and
				acknowledgment of receipt of the guide must be obtained by the insurer. Direct
				response issuers must deliver the guide to the applicant upon request but not
				later than at the time the policy is delivered.
(2) For the purposes of this section, "form"
				means the language, format, type size, type proportional spacing, bold
				character, and line spacing.