Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Appendix 10

Current through June 24, 2024
DISCLOSURE STATEMENTS
(a) [For policies that reimburse expenses incurred for
				specified disease(s) or other specified impairment(s). This includes expense
				incurred cancer, specified disease and other types of health insurance policies
				that limit reimbursement to named medical conditions.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE
				DUPLICATES SOME MEDICARE BENEFITS
This is not Medicare Supplement Insurance
This insurance provides limited benefits, if you meet the
				policy conditions, for hospital or medical expenses only when you are treated
				for one of the specific diseases or health conditions listed in the policy. It
				does not pay your Medicare deductibles or coinsurance and is not a substitute
				for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it
				pays:
hospital or medical expenses up to the maximum stated in the
				policy.
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the "Wisconsin Guide to Health Insurance for
				People with Medicare," available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(b) [Alternative disclosure statement for policies that
				reimburse expenses incurred for specified diseases or other specified
				impairments. This includes expense-incurred cancer, specified disease and other
				types of health insurance policies that limit reimbursement to named medical
				conditions.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS IS NOT MEDICARE
				SUPPLEMENT INSURANCE
Some health care services paid for by Medicare may also
				trigger the payment of benefits from this policy. Medicare generally pays for
				most or all of these expenses.
This insurance provides limited benefits, if you meet the
				policy conditions, for hospital or medical expenses only when you are treated
				for one of the specific diseases or health conditions listed in the policy. It
				does not pay your Medicare deductibles or coinsurance and is not a substitute
				for Medicare Supplement insurance.
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
This policy must pay benefits without regard to other
				health benefit coverage to which you may be entitled under Medicare or other
				insurance.
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the Wisconsin Guide to Health Insurance for People
				with Medicare, available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(c) [For policies that pay fixed dollar amounts for specified
				diseases or other specified impairments. This includes cancer, specified
				disease, and other health insurance policies that pay a scheduled benefit or
				specific payment based on diagnosis of the conditions named in the
				policy.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE
				DUPLICATES SOME MEDICARE BENEFITS
This is not Medicare Supplement Insurance
This insurance pays a fixed amount, regardless of your
				expenses, if you meet the policy conditions, for one of the specific diseases
				or health conditions named in the policy. It does not pay your Medicare
				deductibles or coinsurance and is not a substitute for Medicare Supplement
				insurance.
This insurance duplicates Medicare benefits because
				Medicare generally pays for most of the expenses for the diagnosis and
				treatment of the specific conditions or diagnoses named in the
				policy.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the "Wisconsin Guide to Health Insurance for
				People with Medicare," available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(d) [Alternative disclosure statement for policies that pay
				fixed dollar amounts for specified diseases or other specified impairments.
				This includes cancer, specified disease, and other health insurance policies
				that pay a scheduled benefit or specific payment based on diagnosis of the
				conditions named in the policy.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS IS NOT MEDICARE
				SUPPLEMENT INSURANCE
Some health care services paid for by Medicare may also
				trigger the payment of benefits from this policy.
This insurance pays a fixed amount, regardless of your
				expenses, if you meet the policy conditions, for one of the specific diseases
				or health conditions named in the policy. It does not pay your Medicare
				deductibles or coinsurance and is not a substitute for Medicare Supplement
				insurance.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
This policy must pay benefits without regard to other
				health benefit coverage to which you may be entitled under Medicare or other
				insurance.
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the Wisconsin Guide to Health Insurance for People
				with Medicare, available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(e) [For indemnity policies and other policies that pay a fixed
				dollar amount per day, excluding long-term care policies.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE
				DUPLICATES SOME MEDICARE BENEFITS
This is not Medicare Supplement Insurance
This insurance pays a fixed amount, regardless of your
				expenses, for each day you meet the policy conditions. It does not pay your
				Medicare deductibles or coinsurance and is not a substitute for Medicare
				Supplement insurance.
This insurance duplicates Medicare benefits
				when:
any expenses or services covered by the policy are also
				covered by Medicare.
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the "Wisconsin Guide to Health Insurance for
				People with Medicare," available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(f) [Alternative disclosure statement for indemnity policies
				and other policies that pay a fixed dollar amount per day, excluding long-term
				care policies.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS IS NOT MEDICARE
				SUPPLEMENT INSURANCE
Some health care services paid for by Medicare may also
				trigger the payment of benefits from this policy.
This insurance pays a fixed dollar amount, regardless of your
				expenses, for each day you meet the policy conditions. It does not pay your
				Medicare deductibles or coinsurance and is not a substitute for Medicare
				Supplement insurance.
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
This policy must pay benefits without regard to other
				health benefit coverage to which you may be entitled under Medicare or other
				insurance.
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the "Wisconsin Guide to Health Insurance for
				People with Medicare," available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(g) [For other health insurance policies not specifically
				identified in the previous statements.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE
				DUPLICATES SOME MEDICARE BENEFITS
This is not Medicare Supplement Insurance
This insurance provides limited benefits if you meet the
				conditions listed in the policy. It does not pay your Medicare deductibles or
				coinsurance and is not a substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it
				pays:
*the benefits stated in the policy and coverage for the same
				event is provided by Medicare
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the "Wisconsin Guide to Health Insurance for
				People with Medicare," available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.
(h) [Alternative disclosure statement for other health
				insurance policies not specifically identified in the preceding
				statements.]
IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS IS NOT MEDICARE
				SUPPLEMENT INSURANCE
Some health care services paid for by Medicare may also
				trigger the payment of benefits from this policy.
This insurance provides limited benefits if you meet the
				conditions listed in the policy. It does not pay your Medicare deductibles or
				coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* [outpatient prescription drugs if you are enrolled in
				Medicare Part D]
* other approved items and services
This policy must pay benefits without regard to other
				health benefit coverage to which you may be entitled under Medicare or other
				insurance.
Before You Buy This Insurance
[TICK] Check the coverage in all health insurance policies you
				already have.
[TICK] For more information about Medicare and Medicare
				Supplement insurance, review the "Wisconsin Guide to Health Insurance for
				People with Medicare", available from the insurance company.
[TICK] For help in understanding your health insurance, contact
				your state insurance department or state senior insurance counseling
				program.