Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0160 - Required Disclosure Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The following provisions apply to all
			 Medicare supplement policies and certificates:
(a) Each Medicare supplement policy and
			 certificate shall include a renewal or continuation provision. The language or
			 specifications of the provision must be consistent with the type of contract
			 issued. The provision shall be appropriately captioned, 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 or certificate holder's age;
(b) Each rider or endorsement added to a
			 Medicare supplement policy after the date that the policy is issued or at
			 reinstatement or renewal, that reduces or eliminates benefits or coverage in
			 the policy, shall require a signed acceptance by the insured, 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. After the date of issuance of the policy or
			 certificate, any rider or endorsement that 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. When 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;
(c) Medicare supplement policies or
			 certificates shall 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 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 may return the policy or certificate within
			 30 days of its delivery and may have the premium refunded if, after examination
			 of the policy or certificate, the insured person is not satisfied for any
			 reason;
(f)
(A) An issuer of health policies or
			 certificates that provide hospital or medical expense coverage on an expense
			 incurred or indemnity basis to a person eligible for Medicare shall 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 CMS and in a type size no smaller than 12 point type. Delivery of the Guide
			 shall be made whether or not such policies or certificates are advertised,
			 solicited or issued as Medicare supplement policies or certificates as defined
			 in OAR 836-052-0119. Except in the case of direct response issuers, delivery of
			 the Guide shall be made to the applicant at the time of application, and
			 acknowledgment 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 rule, "form"
			 means the language, format, type size, type proportional spacing, bold
			 character and line spacing.