West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-15 - Required Disclosure Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
15.1. General
				Rules.
15.1.a. Medicare supplement policies and
				certificates 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 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.
15.1.b. 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 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, 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.
15.1.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.
15.1.d. If a Medicare supplement
				policy or certificate contains any limitations with respect to preexisting
				conditions, the limitations shall appear as a separate paragraph of the policy, be
				labeled as "Preexisting Condition Limitations," and be placed on the first page of
				the policy.
15.1.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 shall have the right to return the policy or
				certificate within thirty (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 for any reason.
15.1.f.
				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(s)
				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. For purposes of this section, "form" means the language,
				format, type size, promotional spacing, bold character, and line spacing. Delivery
				of the
Guide
shall be made whether or not the policies or
				certificates are advertised, solicited or issued as Medicare supplement policies or
				certificates as defined in this rule. 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.