West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-17 - Medicare Supplement Insurance Coverage › Section 114-17-6 - Required Disclosure Provisions

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1.
				Term of coverage. -- Each Medicare Supplement or Limited Benefit Medicare Supplement
				policy or contract shall include a renewal, continuation or nonrenewal provision.
				The language or specifications of such provision must be consistent with the type of
				contract to be issued. Such provision shall be appropriately captioned, shall appear
				on the first page of the policy or contract, and shall clearly state the duration,
				where limited, of renewability and the duration of the term of coverage for which
				the policy or contract is issued and for which it may be renewed.
6.2. Payment of benefit standards. -- A Medicare
				Supplement or Limited Benefit Medicare Supplement policy or contract which provides
				for the payment of benefits based on standards described as "Usual and Customary,"
				"Reasonable and Customary," or words of similar import shall include a definition of
				such terms and an explanation of such terms in its accompanying outline of
				coverage.
6.3. Preexisting condition
				limitations. -- If a Medicare Supplement or Limited Benefit Medicare Supplement
				policy or contract contains any limitations with respect to preexisting conditions,
				such limitations must appear as a separate paragraph of the policy or contract and
				be labeled as "Preexisting Condition Limitations."
6.4. Right to return. -- Medicare Supplement or
				Limited Benefit Medicare Supplement policies, certificates or contracts issued to
				persons eligible for Medicare by reason of age, other than those issued pursuant to
				direct response solicitation, shall have a notice prominently printed on the first
				page of the policy, certificate or contract, attached thereto stating in substance
				that the insured person shall have the right to return the policy, certificate or
				contract within ten (10) days of its delivery and to have the premium refunded if,
				after examination of the policy, certificate or contract, the insured person is not
				satisfied by any reason. Policies, certificates or contracts issued pursuant to a
				direct response solicitation to persons eligible for Medicare by reason of age shall
				have a notice prominently printed on the first page or attached thereto stating in
				substance that the policyholder, certificate holder or contract holder shall have
				the right to return the policy, certificate or contract within thirty (30) days of
				its delivery and to have the premium refunded if after examination the insured
				person is not satisfied for any reason.
6.5. Buyer's guide. -- Insurers issuing individual
				or group policies or contracts sold primarily to persons eligible for Medicare by
				reason of age, which provide hospital or medical expense coverage on an expense
				incurred or indemnity basis, other than incidentally, shall provide to the
				policyholder a Medicare Supplement "Buyer's Guide":
Provided,
That such
				"Buyer's Guide" shall, at the time of issuance, reflect current Medicare benefits,
				copayments and deductibles. Delivery of the Buyer's Guide shall be made whether or
				not such policy or contract qualifies as a Medicare Supplement or Limited Benefit
				Medicare Supplement policy as defined in this regulation. Except in the case of
				direct response insurers, delivery of the Buyer's Guide shall be made at the time of
				application, and acknowledgment of receipt of the Buyer's Guide shall be provided to
				the insurer. Direct response insurers shall deliver the Buyer's Guide upon request
				but not later than at the time the policy is delivered.
6.6. Outline of coverage requirements for Medicare
				Supplement and Limited Benefit Medicare Supplement policies, certificates or
				contracts:
(a)
(1) Insurers issuing Medicare Supplement or
				Limited Benefit Medicare Supplement policies, certificates or contracts shall
				deliver an outline of coverage which meets the requirements of this section to the
				applicant at the time application is made and, except for the direct response
				policy, secure an acknowledgment of receipt from the applicant; and
(2) If an outline of coverage was delivered at the
				time of application and the individual policy or contract is issued on a basis which
				would require revision of the outline, a substitute outline of coverage properly
				describing the policy or contract shall accompany such policy or contract when it is
				delivered and shall contain the following statement, in no less than twelve (12)
				point type, immediately above the company name: "NOTICE: Read this outline of
				coverage carefully. It is not identical to the outline of coverage provided upon
				application and the coverage originally applied for has been issued."