Md. Code Regs. 31.10.05.11

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.05.11 - Required Disclosure Provisions

A. General.

(1) Medicare supplement policies shall contain a clearly worded provision regarding the right of the policyholder to renew or continue the policy. This provision shall be appropriately captioned and shall be printed on the first page of the policy.

(2) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured or 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 unless otherwise authorized by the Commissioner. After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing, signed by the insured unless the benefits or coverage are required by the minimum standards for Medicare supplement insurance policies or are required by law. When a separate additional premium is charged for benefits provided in connection with riders or endorsements, the additional premium charge shall be stated in the policy.

(3) A Medicare supplement policy 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 these terms and an explanation of the terms in its accompanying outline of coverage.

(4) If a Medicare supplement policy contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy and may be labeled as "preexisting condition limitations" or a title of similar import.

(5) Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate stating that the policyholder or certificate holder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded.

B. Notice Requirements.

(1) As soon as practicable, but not later than 30 days before the annual effective date of any Medicare benefit changes, each insurer, including any health service plan, which provides Medicare supplement insurance or benefits to a resident of this State, shall notify its policyholders, contract holders, and certificate holders of modifications to be made to Medicare insurance policies or contracts in a manner approved by the Commissioner. In addition, the notice shall:

(a) Include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement insurance policy or contract; and

(b) Inform each covered person as to when any premium adjustment is to be made by reason of changes in Medicare benefits.

(2) The notices of benefit modifications and of any premium adjustments shall be in outline form and in clear and simple terms in order to facilitate comprehension.

(3) The notices may not contain or be accompanied by any solicitation materials.

Md. Code Regs. 31.10.05.11

Regulations .11 and Appendices A_C adopted as an emergency provision effective July 25, 1989 (16:16 Md. R. 1738); emergency status extended at 16:26 Md. R. 2782 and 17:5 Md. R. 633; emergency status expired July 20, 1990
Regulation .11 amended effective January 1, 2006 (32:18 Md. R. 1522)