reglab/statecodes huggingface dataset:
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 6 - Prompt Processing of Claims › Section 230-RICR-20-30-6.13 - Severability

Current through June 14, 2024
If any section, term, or provision of this Part is adjudged
					 invalid for any reason, that judgment shall not affect, impair, or invalidate
					 any remaining section, term, or provision, which shall remain in full force and
					 effect.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.1 - Purpose

Current through June 14, 2024
The purpose of this Part is to provide for the reasonable
					 standardization of coverage and simplification of terms and benefits of
					 Medicare supplement policies; to facilitate public understanding and comparison
					 of such policies; to eliminate provisions contained in such policies which may
					 be misleading or confusing in connection with the purchase of such policies or
					 with the settlement of claims; and to provide for full disclosures in the sale
					 of accident and sickness insurance coverages to persons eligible for
					 Medicare.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.2 - Authority

Current through June 14, 2024
This Part is issued pursuant to the authority vested in the
					 commissioner under R.I. Gen. Laws Chapters 27-18.2, 27-29 and
					 §
										42-62-12.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.3 - Applicability and Scope

Current through June 14, 2024
A. Except as
				  otherwise specifically provided in §§
										7.7,  7.16,  7.17,  7.20  and  7.25    of this Part shall apply to:
1. All Medicare
				  supplement policies delivered or issued for delivery in this state on or after
				  the effective date of this Part; and
2. All certificates issued under group
				  Medicare supplement policies, which certificates have been delivered or issued
				  for delivery in this state.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.4 - Definitions

Current through June 14, 2024
A. For purposes of this Part:
1. "Applicant" means:
a. In the case of an individual Medicare
				  supplement policy, the person who seeks to contract for insurance benefits, and
b. In the case of a group Medicare
				  supplement policy, the proposed certificate holder.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.5 - Policy Definitions and Terms

Current through June 14, 2024
A. No policy or
				  certificate may be advertised, solicited or issued for delivery in this state
				  as a Medicare supplement policy or certificate unless the policy or certificate
				  contains definitions or terms that conform to the requirements of this
				  section.
B. "Accident," "accidental
				  injury," or "accidental means" shall be defined to employ "result" language and
				  shall not include words that establish an accidental means test or use words
				  such as "external, violent, visible wounds" or similar words of description or
				  characterization.
1. The definition shall not
				  be more restrictive than the following: "Injury or injuries for which benefits
				  are provided means accidental bodily injury sustained by the insured person
				  which is the direct result of an accident, independent of disease or bodily
				  infirmity or any other cause, and occurs while insurance coverage is in
				  force."
2. The definition may
				  provide that injuries shall not include injuries for which benefits are
				  provided or available under any workers' compensation, employer's liability or
				  similar law, or motor vehicle no-fault plan, unless prohibited by
				  law.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.6 - Policy Provisions

Current through June 14, 2024
A. Except for
				  permitted preexisting condition clauses as described in §§
										7.7(B)(1),
				   7.8(B)(1)  and  7.9(B)(1)   of this Part, no policy or certificate may be
				  advertised, solicited or issued for delivery in this state as a Medicare
				  supplement policy if the policy or certificate contains limitations or
				  exclusions on coverage that are more restrictive than those of
				  Medicare.
B. No Medicare supplement
				  policy or certificate may use waivers to exclude, limit or reduce coverage or
				  benefits for specifically named or described preexisting diseases or physical
				  conditions.
C. No Medicare
				  supplement policy or certificate in force in the state shall contain benefits
				  that duplicate benefits provided by Medicare.
D. Prescription Drugs Policy
1. Subject to §§
											7.7(B)(4), (5) and
				  (7), and  7.8(B)(4) and (5)   of this Part, a Medicare supplement policy with
				  benefits for outpatient prescription drugs in existence prior to January 1,
				  2006 shall be renewed for current policyholders who do not enroll in Part D at
				  the option of the policyholder.
2.
				  A Medicare supplement policy with benefits for outpatient prescription drugs
				  shall not be issued after December 31, 2005.
3. After December 31, 2005, a Medicare
				  supplement policy with benefits for outpatient prescription drugs may not be
				  renewed after the policyholder enrolls in Medicare Part D unless:
a. The policy is modified to eliminate
				  outpatient prescription coverage for expenses of outpatient prescription drugs
				  incurred after the effective date of the individual's coverage under a Part D
				  plan and;
b. Premiums are adjusted
				  to reflect the elimination of outpatient prescription drug coverage at the time
				  of Medicare Part D enrollment, accounting for any claims paid, if
				  applicable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.11 - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage On or after June 1, 2010

Current through June 14, 2024
A. The following standards are applicable to
				  all Medicare supplement policies or certificates delivered or issued for
				  delivery in this state with an effective date for coverage on or after June 1,
				  2010. No policy or certificate may be advertised, solicited, delivered or
				  issued for delivery in this state as a Medicare supplement policy or
				  certificate unless it complies with these benefit plan standards. Benefit plan
				  standards applicable to Medicare supplement policies and certificates with an
				  effective date for coverage before June 1, 2010 remain subject to the
				  requirements of this Part governing such policies and certificates.
B. Policy Form or Certificate
1. An issuer shall make available to each
				  prospective policyholder and certificate holder a policy form or certificate
				  form containing only the basic (core) benefits, as defined in §
											7.9(C)   of
				  this Part.
2. If an issuer makes
				  available any of the additional benefits described in §
											7.9(D)   of this
				  Part, or offers standardized benefit Plans K or L (as described in
				  §
											7.11(F)(8) and (9)   of this Part), then the issuer shall make available to
				  each prospective policyholder and certificate holder, in addition to a policy
				  form or certificate form with only the basic (core) benefits as described in
				  §
											7.11(B)(1)   of this Part, a policy form or certificate form containing
				  either standardized benefit Plan C (as described in §
											7.11(F)(3)   of this
				  Part) or standardized benefit Plan F (as described in §
											7.11(F)(5)   of this
				  Part).
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.12 - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020

Current through June 14, 2024
A. The Medicare Access and CHIP
				  Reauthorization Act of 2015 (MACRA) requires the following standards applicable
				  to all Medicare supplement policies or certificates delivered or issued for
				  delivery in this state to individuals newly eligible for Medicare on or after
				  January 1, 2020. No policy or certificate that provides coverage of the
				  Medicare Part B deductible may be advertised, solicited, delivered or issued
				  for delivery in this state as a Medicare supplement policy or certificate to
				  individuals newly eligible for Medicare on or after January 1, 2020. All
				  policies must comply with the following benefit standards. Benefit plan
				  standards applicable to Medicare supplement policies and certificates issued to
				  individuals eligible for Medicare before January 1, 2020, remain subject to the
				  requirements of §
										7.11   of this Part.
B. Benefit Requirements. The standards and
				  requirements of §
										7.11   of this Part shall apply to all Medicare supplement
				  policies or certificates delivered or issued for delivery to individuals newly
				  eligible for Medicare on or after January 1, 2020, with the following
				  exceptions:
1. Standardized Medicare
				  supplement benefit Plan C is redesignated as Plan D and shall provide the
				  benefits contained in §
											7.11(F)(3)   of this Part of this regulation but
				  shall not provide coverage for one hundred percent (100%) or any portion of the
				  Medicare Part B deductible.
2.
				  Standardized Medicare supplement benefit Plan F is redesignated as Plan G and
				  shall provide the benefits contained in §
											7.11(F)(5)   of this Part of this
				  regulation but shall not provide coverage for one hundred percent (100%) or any
				  portion of the Medicare Part B deductible.
3. Standardized Medicare supplement benefit
				  plans C, F, and F with High Deductible may not be offered to individuals newly
				  eligible for Medicare on or after January 1, 2020.
4. Standardized Medicare supplement benefit
				  Plan F With High Deductible is redesignated as Plan G With High Deductible and
				  shall provide the benefits contained in §
											7.11(F)(6)   of this Part but shall
				  not provide coverage for one hundred percent (100%) or any portion of the
				  Medicare Part B deductible; provided further that, the Medicare Part B
				  deductible paid by the beneficiary shall be considered an out-of-pocket expense
				  in meeting the annual high deductible.
5. The reference to Plans C or F contained in
				  §
											7.11(B)(2)   is deemed a reference to Plans D or G for purposes of this
				  section
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.13 - Medicare Select Policies and Certificates

Current through June 14, 2024
A. This
				  section shall apply to Medicare Select policies and certificates, as defined in
				  this section.
1. No policy or certificate may
				  be advertised as a Medicare Select policy or certificate unless it meets the
				  requirements of this section.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.14 - Open Enrollment

Current through June 14, 2024
A. An issuer shall
				  not deny or condition the issuance or effectiveness of any Medicare supplement
				  policy or certificate available for sale in this state, nor discriminate in the
				  pricing of a policy or certificate because of the health status, claims
				  experience, receipt of health care, or medical condition of an applicant in the
				  case of an application for a policy or certificate that is submitted prior to
				  or during the six (6) month period beginning with the first day of the first
				  month in which an individual is both 65 years of age or older and is enrolled
				  for benefits under Medicare Part B. Each Medicare supplement policy and
				  certificate currently available from an insurer shall be made available to all
				  applicants who qualify under this subsection without regard to age.
B. If an applicant qualifies under
				  §
										7.14(A)   of this Part and submits an application during the time period
				  referenced in §
										7.14(A)   of this Part and, as of the date of application,
				  has had a continuous period of creditable coverage of at least six (6) months,
				  the issuer shall not exclude benefits based on a preexisting condition.
1. If the applicant qualifies under
				  §
											7.14(A)   of this Part and submits an application during the time period
				  referenced in §
											7.14(A)   of this Part and, as of the date of application,
				  has had a continuous period of creditable coverage that is less than six (6)
				  months, the issuer shall reduce the period of any preexisting condition
				  exclusion by the aggregate of the period of creditable coverage applicable to
				  the applicant as of the enrollment date. The Secretary shall specify the manner
				  of the reduction under this subsection.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.15 - Guaranteed Issue for Eligible Persons

Current through June 14, 2024
A. Guaranteed
				  Issue:
1. Eligible persons are those
				  individuals described in §
											7.15(B)   of this Part who seek to enroll under
				  the policy during the period specified in §
											7.15(C)   of this Part, and who
				  submit evidence of the date of termination, disenrollment, or Medicare Part D
				  enrollment with the application for a Medicare supplement policy.
2. With respect to eligible persons, an
				  issuer shall not deny or condition the issuance or effectiveness of a Medicare
				  supplement policy described in §
											7.15(E)   of this Part that is offered and
				  is available for issuance to new enrollees by the issuer, shall not
				  discriminate in the pricing of such a Medicare supplement policy because of
				  health status, claims experience, receipt of health care, or medical condition,
				  and shall not impose an exclusion of benefits based on a preexisting condition
				  under such a Medicare supplement policy.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.16 - Standards for Claims Payment

Current through June 14, 2024
A. An issuer shall
				  comply with section  1882(c)(3)   of the Social Security Act (as enacted by
				  section  4081(b)(2)(C)   of the Omnibus Budget Reconciliation Act of 1987 (OBRA)
				  1987, Pub. L. No. 100-203) by:
1. Accepting a
				  notice from a Medicare carrier on dually assigned claims submitted by
				  participating physicians and suppliers as a claim for benefits in place of any
				  other claim form otherwise required and making a payment determination on the
				  basis of the information contained in that notice;
2. Notifying the participating physician or
				  supplier and the beneficiary of the payment determination;
3. Paying the participating physician or
				  supplier directly;
4. Furnishing,
				  at the time of enrollment, each enrollee with a card listing the policy name,
				  number and a central mailing address to which notices from a Medicare carrier
				  may be sent;
5. Paying user fees
				  for claim notices that are transmitted electronically or otherwise;
				  and
6. Providing to the Secretary
				  of Health and Human Services, at least annually, a central mailing address to
				  which all claims may be sent by Medicare carriers.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.17 - Loss Ratio Standards and Refund or Credit of Premium

Current through June 14, 2024
A. Loss Ratio Standards.
1. A Medicare Supplement policy form or
				  certificate form shall not be delivered or issued for delivery unless the
				  policy form or certificate form can be expected, as estimated for the entire
				  period for which rates are computed to provide coverage, to return to
				  policyholders and certificate holders in the form of aggregate benefits (not
				  including anticipated refunds or credits) provided under the policy form or
				  certificate form:
a. At least seventy-five
				  percent (75%) of the aggregate amount of premiums earned in the case of group
				  policies; or
b. At least sixty-five
				  percent (65%) of the aggregate amount of premiums earned in the case of
				  individual policies;
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.18 - Filing and Approval of Policies and Certificates and Premium Rates

Current through June 14, 2024
A. An issuer shall not deliver or issue for
				  delivery a policy or certificate to a resident of this state unless the policy
				  form or certificate form has been filed with and approved by the commissioner
				  in accordance with filing requirements and procedures prescribed by the
				  commissioner.
B. An issuer shall
				  file any riders or amendments to policy or certificate forms to delete
				  outpatient prescription drug benefits as required by the Medicare Prescription
				  Drug, Improvement, and Modernization Act of 2003 only with the commissioner in
				  the state in which the policy or certificate was issued.
C. An issuer shall not use or change premium
				  rates for a Medicare supplement policy or certificate unless the rates, rating
				  schedule and supporting documentation have been filed with and approved by the
				  commissioner in accordance with the filing requirements and procedures
				  prescribed by the commissioner.
D.
				  Except as provided in §
										7.18(D)(1)   of this Part, an issuer shall not file
				  for approval more than one form of a policy or certificate of each type for
				  each standard Medicare supplement benefit plan.
1. An issuer may offer, with the approval of
				  the commissioner, up to four (4) additional policy forms or certificate forms
				  of the same type for the same standard Medicare supplement benefit plan, one
				  for each of the following cases:
a. The
				  inclusion of new or innovative benefits;
b. The addition of either direct response or
				  agent marketing methods;
c. The
				  addition of either guaranteed issue or underwritten coverage;
d. The offering of coverage to individuals
				  eligible for Medicare by reason of disability.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.19 - Permitted Compensation Arrangements

Current through June 14, 2024
A. An issuer or
				  other entity may provide commission or other compensation to an agent or other
				  representative for the sale of a Medicare supplement policy or certificate only
				  if the first-year commission or other first year compensation is no more than
				  200 percent of the commission or other compensation paid for selling or
				  servicing the policy or certificate in the second year or period.
B. The commission or other compensation
				  provided in subsequent (renewal) years must be the same as that provided in the
				  second year or period and must be provided for no fewer than five (5) renewal
				  years.
C. No issuer or other entity
				  shall provide compensation to its agents or other producers and no agent or
				  producer shall receive compensation greater than the renewal compensation
				  payable by the replacing issuer on renewal policies or certificates if an
				  existing policy or certificate is replaced.
D. For purposes of this section,
				  "compensation" includes pecuniary or non-pecuniary remuneration of any kind
				  relating to the sale or renewal of the policy or certificate including but not
				  limited to bonuses, gifts, prizes, awards and finder's fees.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.22 - Filing Requirements for Advertising

Current through June 14, 2024
An issuer shall provide a copy of any Medicare supplement
					 advertisement intended for use in this state whether through written, radio or
					 television medium to the commissioner for review or approval by the
					 commissioner to the extent it may be required under state
					 law.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.23 - Standards for Marketing

Current through June 14, 2024
A. An issuer,
				  directly or through its producers, shall:
1.
				  Establish marketing procedures to assure that any comparison of policies by its
				  agents or other producers will be fair and accurate.
2. Establish marketing procedures to assure
				  excessive insurance is not sold or issued.
3. Display prominently by type, stamp or
				  other appropriate means, on the first page of the policy the following: "Notice
				  to buyer: This policy may not cover all of your medical expenses."
4. Inquire and otherwise make every
				  reasonable effort to identify whether a prospective applicant or enrollee for
				  Medicare supplement insurance already has accident and sickness insurance and
				  the types and amounts of any such insurance.
5. Establish auditable procedures for
				  verifying compliance with §
											7.23(A)   of this Part.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.24 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through June 14, 2024
A. In recommendation the purchase or
				  replacement of any Medicare supplement policy or certificate an agent shall
				  make reasonable efforts to determine the appropriateness of a recommended
				  purchase or replacement.
B. Any
				  sale of a Medicare supplement policy or certificate that will provide an
				  individual more than one Medicare supplement policy or certificate is
				  prohibited.
C. An issuer shall not
				  issue a Medicare supplement policy or certificate to an individual enrolled in
				  Medicare Part C unless that effective dates of the coverage is after
				  termination date of the individual's Part C coverage.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.25 - Reporting of Multiple Policies

Current through June 14, 2024
A. On or before
				  March 1 of each year, an issuer shall report the following information for
				  every individual resident of this state for which the issuer has in force man
				  than one Medicare supplement policy or certificate:
1. Policy and certificate number;
				  and
2. Date of issuance
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.26 - Prohibition against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates

Current through June 14, 2024
A. If a Medicare supplement policy or
				  certificate replaces another Medicare supplement policy or certificate, the
				  replacing issuer shall waive any time periods applicable to preexisting
				  conditions, waiting periods, elimination periods and probationary periods in
				  the new Medicare supplement policy or certificate for similar benefits to the
				  extent such time was spent under the original policy.
B. If a Medicare supplement policy or
				  certificate replaces another Medicare supplement policy or certificate which
				  has been in effect for at least six (6) months, the replacing policy shall not
				  provide any time period applicable to preexisting conditions, waiting periods,
				  elimination periods and probationary periods.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.27 - Prohibition against Use of Genetic Information and Requests for Genetic Testing

Current through June 14, 2024
A. This Section
				  applies to all policies with policy years beginning on or after May 21, 2009.
1. An issuer of a Medicare supplement policy
				  or certificate;
a. Shall not deny or
				  condition the issuance or effectiveness of the policy or certificate (including
				  the imposition of any exclusion of benefits under the policy based on a
				  pre-existing condition) on the basis of the genetic information with respect to
				  such individual; and
b. Shall not
				  discriminate in the pricing of the policy or certificate (including the
				  adjustment of premium rates) of an individual on the basis of the genetic
				  information with respect to such individual.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.28 - Severability

Current through June 14, 2024
If any provision of this Part or the application thereof to
					 any person or circumstance is for any reason held to be invalid, the remainder
					 of the Part and the application of such provision to other persons or
					 circumstances shall not be affected thereby.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.1 - Authority

Current through June 14, 2024
This Part is issued pursuant to R.I. Gen. Laws Chapters
					 27-18.2, 27-29 and R.I. Gen. Laws §§
										42-62-12.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.2 - Purpose

Current through June 14, 2024
The purpose of this Part is to provide prospective
					 purchasers with clear and unambiguous statements in the advertisement of
					 Medicare supplement insurance; to assure the clear and truthful disclosure of
					 the benefits, limitations and exclusions of policies sold as Medicare
					 supplement insurance. This purpose is intended to be accomplished by the
					 establishment of guidelines and permissible and impermissible standards of
					 conduct in the advertising of Medicare supplement insurance in a manner which
					 prevents unfair, deceptive and misleading advertising and is conducive to
					 accurate presentation and description to the insurance-buying public through
					 the advertising media and material used by insurance agents and companies.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.3 - Applicability

Current through June 14, 2024
A. These rules shall apply to any
				  "advertisement" of Medicare supplement insurance as that term is defined
				  herein, unless otherwise specified in these rules, that the insurer knows or
				  reasonably should know is intended for presentation, distribution or
				  dissemination in this state when the presentation, distribution or
				  dissemination is made either directly or indirectly by or on behalf of an
				  insurer, agent, broker, producer or solicitor, as those terms are defined in
				  Title 27 and in this Part.
B. Every
				  insurer shall establish and at all times maintain a system of control over the
				  content, form and method of dissemination of all of its Medicare supplement
				  insurance advertisements. All such advertisements, regardless of by whom
				  written, created, designed or presented, shall be the responsibility of the
				  insurers benefiting directly or indirectly from their dissemination.
C. Advertising materials that are reproduced
				  in quantity shall be identified by form numbers or other identifying means. The
				  identification shall be sufficient to distinguish an advertisement from any
				  other advertising materials, policies, applications or other materials used by
				  the insurer.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.4 - Definitions

Current through June 14, 2024
A. "Advertisement":
1. An advertisement for the purpose of these
				  rules shall include:
a. Printed and published
				  material, audio visual material and descriptive literature used by or on behalf
				  of an insurer in direct mail, newspapers, magazines, radio scripts, TV scripts,
				  billboards and similar displays;
b.
				  Descriptive literature and sales aids of all kinds issued by an insurer, agent,
				  producer, broker or solicitor for presentation to members of the
				  insurance-buying public; including but not limited to, circular, leaflets,
				  booklets, depictions, illustrations, form letters and lead generating devices
				  of all kinds as defined in this rule; and
c. Prepared sales talks, presentations and
				  material for use by agents, brokers, producers and solicitors, whether prepared
				  by the insurer or the agent, broker, producer or solicitor.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.5 - Method of Disclosure of Required Information

Current through June 14, 2024
All information required to be disclosed by these rules
					 shall be set out conspicuously and in close conjunction with the statements to
					 which the information relates or under appropriate captions of such prominence
					 that it shall not be minimized, rendered obscure or presented in an ambiguous
					 manner or fashion or intermingled with the context of the advertisement so as
					 to be confusing or misleading.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.6 - Form and Content of Advertisements

Current through June 14, 2024
A. The format
				  and content of a Medicare supplement insurance advertisement shall be
				  sufficiently complete and clear to avoid deception or the capacity or tendency
				  to mislead or deceive. Whether an advertisement has a capacity or tendency to
				  mislead or deceive shall be determined by the commissioner of insurance from
				  the overall impression that the advertisement may be reasonably expected to
				  create upon a person of average education or intelligence, within the segment
				  of the public to which it is directed.
B. Advertisements shall be truthful and not
				  misleading in fact or in implication words or phrases whose meanings are clear
				  only by implication or by the consumer's familiarity with insurance terminology
				  shall not be used.
C. An insurer
				  must clearly identify its Medicare supplement insurance policy as an insurance
				  policy (or a subscriber contract, certificate or other term appropriate to the
				  insurer). A policy trade name must be followed by the words..."Insurance
				  Policy" (or other appropriate term) or similar words clearly identifying the
				  fact that an insurance policy or health benefits product (in the case of health
				  maintenance organizations, prepaid health plans and other direct service
				  organizations) is being offered.
D.
				  No insurer, agent, broker producer, solicitor or other person shall solicit a
				  resident of this state for the purchase of Medicare supplement insurance in
				  connection with or as the result of the use of any advertisement by such person
				  or any other person, where the advertisement:
1. Contains any misleading representations or
				  misrepresentations, or is otherwise untrue, deceptive or misleading with regard
				  to the information imparted, the status, character or representative capacity
				  of such person or the true purpose of the advertisement; or
2. Otherwise violates the provisions of these
				  rules
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.8 - Necessity for Disclosing Policy Provisions Relating to Renewability, Cancelability and Termination

Current through June 14, 2024
An advertisement that is an invitation to contract shall
					 disclose the provisions relating to renewability, cancelability and termination
					 and any modification of benefits, losses covered or premiums because of age or
					 for other reasons, in a manner which shall not minimize or render obscure the
					 qualifying conditions.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.9 - Testimonials or Endorsements by Third Parties

Current through June 14, 2024
A.
				  Testimonials and endorsements used in advertisements must be genuine, represent
				  the current opinion of the author, be applicable to the policy advertised and
				  be accurately reproduced. The insurer, in using a testimonial or endorsement,
				  makes as its own all of the statements contained therein, and the
				  advertisement, including the statement, is subject to all the provisions of
				  these rules. When a testimonial or endorsement is used more than one year after
				  it was originally given, a confirmation must be obtained.
B. A person shall be deemed a "spokesperson"
				  if the person making the testimonial or endorsement:
1. Has a financial interest in the insurer or
				  a related entity as a stockholder, director, officer, employee or
				  otherwise;
2. Has been formed by
				  the insurer, is owned or controlled by the insurer, its employees, or the
				  person or persons who own or control the insurer;
3. Has any person in a policy-making position
				  who is affiliated with the insurer in any of the above described capacities;
				  or
4. Is in any way directly or
				  indirectly compensated for making a testimonial or endorsement
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.10 - Use of Statistics

Current through June 14, 2024
A. An advertisement
				  relating to the dollar amounts of claims paid, the number of persons insured,
				  or similar statistical information relating to any insurer or policy shall not
				  use irrelevant facts, and shall not be used unless it accurately reflects all
				  of the relevant facts. Such an advertisement shall not imply that the
				  statistics are derived from a policy advertised unless such is the fact, and
				  when applicable to other policies or plans shall specifically so state
1. An advertisement shall specifically
				  identify the Medicare supplement insurance policy to which statistics relate
				  and, where statistics are given which are applicable to a different policy, it
				  shall be stated clearly that the data do not relate to the policy being
				  advertised.
2. An advertisement
				  using statistics that describe an insurer, such as assets, corporate structure,
				  financial standing, age, product lines or relative position in the insurance
				  business, may be irrelevant and, if used at all, must be used with extreme
				  caution because of the potential for misleading the public. As a specific
				  example, an advertisement for Medicare supplement insurance that refers to the
				  amount of life insurance that the company has in force or the amounts paid out
				  in life insurance benefits is not permissible unless the advertisement clearly
				  indicates the amount paid out for each line of insurance.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.11 - Disparage Comparisons and Statements

Current through June 14, 2024
A. An advertisement
				  shall not directly or indirectly make unfair or incomplete comparisons of
				  policies or benefits or comparisons of non-comparable policies of other
				  insurers, and shall not disparage competitors, their policies, services or
				  business methods, and shall not disparage or unfairly minimize competing
				  methods of marketing insurance.
B.
				  An advertisement shall not contain statements such as "no red tape" or "here is
				  all you do to receive benefits."
C.
				  Advertisements that state or imply that competing insurance coverages
				  customarily contain certain exceptions, reductions or limitations not contained
				  in the advertised policies are unacceptable unless the exceptions, reductions
				  or limitations are contained in a substantial majority of the competing
				  coverages.
D. Advertisements that
				  state or imply that an insurer's premiums are lower or that its loss ratios are
				  higher because its organizational structure differs from that of competing
				  insurers are unacceptable.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.12 - Jurisdictional Licensing and Status of Insurer

Current through June 14, 2024
A. An
				  advertisement that is intended to be seen or heard beyond the limits of the
				  jurisdiction in which the insurer is licensed shall not imply licensing beyond
				  those limits.
B. An advertisement
				  shall not create the impression directly or indirectly that the insurer, its
				  financial condition or status; or the payment of its claims; or the merits,
				  desirability or advisability of its policy forms or kinds of plans of insurance
				  are approved, endorsed or accredited by any division or agency of this state or
				  the United States government.
C. An
				  advertisement shall not imply that approval, endorsement or accreditation of
				  policy forms or advertising has been granted by any division or agency of the
				  state or federal government. "Approval" of either policy forms or advertising
				  shall not be used by an insurer to imply or state that a governmental agency
				  has endorsed or recommended the insurer, its policies, advertising or its
				  financial conditions.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.13 - Identity of Insurer

Current through June 14, 2024
A. The name of the
				  actual insurer shall be stated in all of its advertisements. The form number or
				  numbers of the policy advertised shall be stated in an advertisement that is an
				  invitation to contract. An advertisement shall not use a trade name, an
				  insurance group designation, name of the parent company of the insurer, name of
				  a particular division of the insurer, service mark, slogan, symbol or other
				  device that with or without disclosing the name of the actual insurer would
				  have the capacity and tendency to mislead or deceive as to the true identity of
				  the insurer.
B. No advertisement
				  shall use any combination of words, symbols or physical materials that by their
				  content, phraseology, shape, color or other characteristics are so similar to
				  combination of words, symbols or physical materials used by agencies of the
				  federal government or of this state, or otherwise appear to be of such a nature
				  that is tends to confuse or mislead prospective insureds into believing that
				  the solicitation is in some manner connected with an agency of the municipal,
				  state or federal government.
C.
				  Advertisements, envelopes or stationery that employ words, letters, initials,
				  symbols or other devices that are so similar to those used by governmental
				  agencies or other insurers are not permitted if they may lead the public to
				  believe:
1. That the advertised coverages are
				  somehow provided by or are endorsed by the governmental agencies or the other
				  insurers;
2. That the advertiser is
				  the same as, is connected with or is endorsed by the governmental agencies or
				  the other insurers.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.14 - Group or Quasi-Group Implications

Current through June 14, 2024
A. An
				  advertisement of a particular policy shall not state or imply that prospective
				  insureds become group or quasi-group members covered under a group policy and
				  as such enjoy special rates or underwriting privileges, unless that is the
				  fact.
B. This rule prohibits the
				  solicitation of a particular class, such as governmental employees, by use of
				  advertisements that state or imply that their occupational status entitles them
				  to reduced rates on a group or other basis when, in fact, the policy being
				  advertised is sold only on an individual basis at regular rates.
Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 8 - Advertisements of Medicare Supplement Insurance (formerly OHIC Regulation 9) (230-RICR-20-30-8) › Section 230-RICR-20-30-8.15 - Introductory, Initial or Special Offers

Current through June 14, 2024
A. Standards
1. An advertisement of an individual policy
				  shall not directly or by implication represent that a contract or combination
				  of contracts is an introductory, initial or special offer, or that applicants
				  will receive substantial advantages not available at a later date, or that the
				  offer is available only to a specified group of individuals, unless such is the
				  fact. An advertisement shall not contain phrases describing an enrollment
				  period as "special," "limited," or similar words or phrases when the insurer
				  uses such enrollment periods as the usual method of advertising Medicare
				  supplement insurance.
2. An
				  enrollment period during which a particular insurance product may be purchased
				  on an individual basis shall not be offered within this state unless there has
				  been a lapse of not less than six (6) months between the close of the
				  immediately preceding enrollment period for the same product and the opening of
				  the new enrollment period. The advertisement shall indicate the date by which
				  the applicant must mail the application, which shall be not less than ten (10)
				  days and not more than forty (40) days from the date that the enrollment period
				  is advertised for the first time. This rule applies to all advertising media,
				  i.e., mail, newspapers, radio, television, magazines and periodicals, by any
				  one insurer. It is not applicable to solicitations of employees or members of a
				  particular group or association that otherwise would be eligible under specific
				  provisions of the Insurance Code for group, blanket or franchise insurance. The
				  phrase "any one insurer" includes all the affiliated companies of a group of
				  insurance companies under common management or control.
3. This rule prohibits any statement or
				  implication to the effect that only a specific number of policies will be sold,
				  or that a time is fixed for the discontinuance of the sale of the particular
				  policy advertised because of special advantages available in the policy, unless
				  that is the fact.
4. The phrase "a
				  particular insurance product" in Paragraph (2) of this subsection means an
				  insurance policy that provides substantially different benefits than those
				  contained in any other policy. Different terms of renewability, an increase or
				  decrease in the dollar amounts of benefits, or an increase or decrease in any
				  elimination period or waiting period from those available during an enrollment
				  period for another policy shall not be sufficient to constitute the product
				  being offered as a different product eligible for concurrent or overlapping
				  enrollment periods.