Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter K - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 89.783 - Required disclosure provisions

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
General rules
.
(1) Medicare supplement policies and
				  certificates shall include a renewal or continuation provision. The language or
				  specifications of this provision shall be consistent with the type of contract
				  issued. This 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)
				  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, riders or endorsements added to a
				  Medicare supplement policy after the 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, a 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. 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.
(3) 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 similar
				  words.
(4) If a Medicare supplement
				  policy or certificate contains any limitations with respect to preexisting
				  conditions, these limitations shall appear as a separate paragraph of the
				  policy and be labeled as "Preexisting Condition Limitations."
(5) 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 certificateholder has the right to return the policy or
				  certificate within 30 days of its delivery and to have the premium refunded if,
				  after examination of the policy or certificate, the insured person is not
				  satisfied. The notice shall contain a company mailing address to which the
				  policyholder or certificateholder should direct the return policy or
				  certificate. Upon receipt of a request for a refund, the company shall promptly
				  refund the total premium amount paid directly to the policyholder or
				  certificateholder. When an insurer asks questions in the application concerning
				  the medical history of an individual applying for "coverage," a notice shall be
				  given to the individual urging them to verify the accuracy and completeness of
				  the medical history information on the application and warning them that
				  erroneous or incomplete application data could jeopardize their
				  claim.
(6) Issuers of accident and
				  sickness policies or certificates which provide hospital or medical expense
				  coverage on an expense incurred or indemnity basis to a person eligible for
				  Medicare, shall provide to these applicants a
Guide to Health Insurance
				  for People with Medicare
in the form developed jointly by the National
				  Association of Insurance Commissioners and Centers for Medicare & Medicaid
				  Services (CMS) and in a type size no smaller than 12-point type. Delivery of
				  the
Guide
shall be made whether or not these policies or
				  certificates are advertised, solicited or issued as Medicare supplement
				  policies or certificates as defined in this subchapter. 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 issuers. Direct response
				  issuers shall deliver the
Guide
to the applicant upon request
				  but not later than at the time the policy is delivered.
(7) For the purposes of this section, "form"
				  means the language, format, type size, type proportional spacing, bold
				  character and line spacing.