Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter T - MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 3.3308 - Required Disclosure Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  General rules.
(1) Medicare supplement
				  policies and certificates must include a renewal or continuation provision. The
				  language or specifications of the renewal or continuation provision must be
				  consistent with the type of contract issued. The provision must be
				  appropriately captioned, appear on the first page of the policy, and include
				  any reservation by the issuer of the right to change premiums and any automatic
				  renewal premium increases based on the age of the policyholder.
(2) Except for riders or endorsements by
				  which the issuer effectuates a request made in writing by the policyholder, or
				  by which the issuer exercises a specifically reserved right under a Medicare
				  supplement policy, or by which the issuer is required to reduce or eliminate
				  benefits to avoid duplication of Medicare benefits, all riders or endorsements
				  added to a Medicare supplement policy after the date of issue or at
				  reinstatement or renewal that reduce or eliminate benefits or coverage in the
				  policy must require signed acceptance by the policyholder. After the date of
				  issue of the policy or certificate, any rider or endorsement that increases
				  benefits or coverage with concomitant increase in premium during the policy
				  term must be agreed to in writing and signed by the policyholder unless the
				  benefits are required by the minimum standards for Medicare supplement
				  insurance policies, or unless 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 additional premium charge must be
				  set forth in the policy.
(3)
				  Medicare supplement policies may not provide for the payment of benefits based
				  on standards described as "usual and customary," "reasonable and customary," or
				  similar words and phrases.
(4) If a
				  Medicare supplement policy or certificate contains any limitations with respect
				  to preexisting conditions:
(A) the limitations
				  must appear as a separate paragraph of the policy or certificate and be labeled
				  as "Preexisting Condition Limitations;"
(B) the policy or certificate must define the
				  term "preexisting condition" and must provide an explanation of the term in its
				  accompanying outline of coverage; and
(C) the policy or certificate must include a
				  provision explaining the reduction of the preexisting condition limitation for
				  individuals who qualify under §
												3.3306(b)(1)(A)
				  of this title (relating to Minimum Benefit Standards), §
												3.3312(a)(2)
				  of this title (relating to Guaranteed Issue for Eligible Persons), or §
												3.3324(c) and
				  (d) of this title (relating to Open
				  Enrollment).
(5) Medicare
				  supplement policies and certificates must have a notice prominently printed on
				  the first page or attached to the first page stating in substance that the
				  policyholder or certificate holder has the right to return the policy or
				  certificate within 30 days of its delivery and to have the premium refunded if,
				  after examination, the insured person is not satisfied for any
				  reason.
(6) Issuers of accident and
				  sickness policies, certificates, or subscriber contracts that 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 (Guide) in the form developed jointly
				  by the National Association of Insurance Commissioners and the Centers for
				  Medicare and Medicaid Services of the United States Department of Health and
				  Human Services in no smaller than 12-point type.
(A) For purposes of this section, "form"
				  means the language, format, style, type size, type proportional spacing, bold
				  character, and line spacing.
(B) If
				  a Guide incorporating the latest statutory changes is not available from a
				  government agency, companies may comply with this provision by modifying the
				  latest available Guide to the extent required by applicable law.
(C) Except as provided in this section,
				  delivery of the Guide must be made whether or not any policies, certificates,
				  subscriber contracts, or evidences of coverage are advertised, solicited, or
				  issued as Medicare supplement policies or certificates as defined in this
				  regulation.
(D) 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 from the applicant by the issuer. Issuers must deliver the Guide to
				  the applicant for a direct response Medicare supplement policy on request, but
				  not later than at the time the policy is delivered.
(7) Except as otherwise provided in this
				  section, the terms "Medicare Supplement," "Medigap," "Medicare Wrap-Around,"
				  and similar words or phrases may not be used unless the policy is issued in
				  compliance with §
											3.3306
				  of this title.