Disclosure standards: outline of coverage

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  • (a) In order to provide for full and fair disclosure of Medicare supplement policies, no Medicare supplement policy shall be delivered or issued for delivery in the Territory, and no certificate shall be delivered pursuant to a group Medicare supplement policy delivered or issued for delivery in the Territory unless an outline of coverage is delivered to the applicant at the time application is made.

  • (b) The Commissioner shall prescribe the format and content of the outline of coverage required by subsection (a) of this section. For the purposes of this section, “format” means style, arrangement and overall appearance, including such items as the size, color and prominence of type and the arrangement of text and captions. The outline of coverage shall include:

    • (1) A description of the principal benefits and coverage provided in the policy or contract;

    • (2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums; and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age.

    • (3) A statement that the outline of coverage is a summary of the policy issued or applied for, and that the policy should be consulted to determine governing contractual provisions.

  • (c) The Commissioner may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of Medicare. Except in the case of direct response solicitation insurance policies, the Commissioner may require by regulation that the informational brochure be provided to any prospective insureds or subscribers eligible for Medicare concurrently with delivery of the outline of coverage. With respect to direct response solicitation insurance policies, the Commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds or subscribers eligible for Medicare, but in no event later than the time of policy or contract delivery.

  • (d) The Commissioner may adopt regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not Medicare supplement coverages, for all accident and sickness insurance policies sold to persons eligible for Medicare by reason of age, other than:

    • (1) Medicare supplement policies;

    • (2) Disability income policies;

    • (3) Basic, catastrophic, or major medical expense or policies; or

    • (4) Single premium, nonrenewable policies.

  • (e) The Commissioner may adopt regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, or certificates subscriber contracts by persons eligible for Medicare.


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