Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-150 - Required disclosure provisions

Current through Register Vol. 40, No. 24, July 15, 2024
A. General rules.
1. Medicare supplement policies and
				certificates shall include a renewal or continuation provision. The language or
				specifications of such provision shall 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 age. Medicare supplement policies or certificates which
				are attained age rated shall include a clear and prominent statement, in at
				least 14 point type, disclosing that premiums will increase due to changes in
				age and the frequency under which such changes will occur.
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, 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 shall 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 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. Where 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 shall not provide for the payment of benefits based on
				standards described as "usual and customary," "reasonable and customary" or
				words of similar import.
4. If a
				Medicare supplement policy or certificate contains any limitations with respect
				to preexisting conditions, such 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 shall have the right to
				return the policy or certificate within 30 days of its delivery and to have all
				premiums made for the policy refunded if, after examination of the policy or
				certificate, the insured person is not satisfied for any reason.
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 or persons 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 the Centers for Medicare and Medicaid Services
				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 this
				chapter. Except in the case of direct response issuers, delivery of the guide
				shall be made to the applicant at the time of application and acknowledgement
				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.
For the purposes of this section, "form" means the language,
				  format, type size, type proportional spacing, bold character, and line
				  spacing.