Section R590-146-17 - Required Disclosure Provisions(1)(a) A policy or certificate shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent with the type of policy issued. The provision shall be appropriately captioned, appear on the first page of the policy or certificate, and include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the insured's age.(b)(i) A rider or endorsement added to a policy after the date of issue or at reinstatement or renewal that reduces or eliminates a benefit or coverage in the policy shall require a signed acceptance by the insured, unless the issuer: (A) is effectuating a request made in writing by the insured;(B) is exercising a specifically reserved right under a policy; or(C) is required to reduce or eliminate benefits to avoid duplication of Medicare benefits.(ii) After the issue date of a policy or certificate, a rider or endorsement that increases benefits or coverage with an associated increase in premium during the policy term shall be agreed to in writing signed by the insured, unless:(A) the benefits are required by the minimum standards for Medicare supplement insurance policies; or(B) the increased benefit or coverage is required by law.(iii) When a separate additional premium is charged for benefits provided in connection with a rider or endorsement, the premium charge shall be stated in the policy.(c) A policy or certificate may not provide for the payment of benefits based on standards described as "usual and customary," "reasonable and customary," or similar words.(d) If a policy or certificate contains a limitation regarding a preexisting condition, the limitation shall appear as a separate section of the policy and be labeled as "Preexisting Condition Limitations."(e) A policy and certificate shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating that the policyholder or certificate holder has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the insured is not satisfied for any reason.(f)(i) An issuer of an accident and health insurance policy or certificate that provides hospital or medical expense coverage on an expense incurred or indemnity basis to an individual eligible for Medicare shall provide to the applicant the Guide to Health Insurance for People with Medicare in the form developed jointly by the NAIC and the Centers for Medicare and Medicaid Services in a font no smaller than 12-point.(ii) Delivery of the guide shall be made whether or not the policy or certificate is advertised, solicited, or issued as a Medicare supplement insurance policy or certificate (A) Except in the case of a direct response issuer, delivery of the guide shall be made to the applicant at application and acknowledgement of receipt of the guide shall be obtained by the issuer.(B) A direct response issuer shall deliver the guide to the applicant upon request but not later than when the policy is delivered.(2)(a) As soon as practicable, but no later than 30 days before the annual effective date of any Medicare benefit change, an issuer shall notify each policyholder and certificate holder of a modification it has made to a policy or certificate in a format acceptable to the commissioner. The notice shall: (i) include a description of the revisions to the Medicare program and a description of each modification made to the coverage provided under the policy or certificate; and(ii) inform each policyholder or certificate holder when a premium adjustment is made due to changes in Medicare. (b) The notice of a benefit modification and any premium adjustment shall be in outline form and in clear and simple terms.(c) A notice may not contain or be accompanied by any solicitation.(3)(a) An issuer shall provide an outline of coverage to an applicant when the application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgement of receipt of the outline of coverage from the applicant.(b) If an outline of coverage is provided at the time of application and a policy or certificate is issued on a basis that requires a revision to the outline of coverage, a substitute outline of coverage describing the policy or certificate shall accompany the policy or certificate when it is delivered, and shall state, in no less than 12-point bold font, 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 not been issued."(c)(i) The outline of coverage shall be in no less than 12-point font and include five parts, in the following order: (C) Benefit Chart of Medicare Supplement Plans Sold on or After January 1, 2020;(D) Outline of Coverage Disclosures; and(E) Standardized Plan Description for each standardized plan offered by the issuer.(ii) Each standardized plan shall be shown on the cover page, and the plans offered by the issuer shall be prominently identified.(iii)(A) Premium information for the offered plans shall be shown on the cover page or immediately following the cover page, and shall be prominently displayed.(B) The premium and payment mode shall be stated for each plan that is offered to the applicant.(C) Each possible premium for the applicant shall be illustrated.(4)(a) An accident and health insurance policy or certificate, other than a Medicare supplement insurance policy, or other policy identified in Subsection 31A-22-620(2)(b), issued for delivery in this state to an individual eligible for Medicare, shall notify an insured that the policy is not a Medicare supplement insurance policy or certificate. The notice shall either be printed or attached to the first page of the outline of coverage delivered to an insured, or if no outline of coverage is delivered, to the first page of the accident and health insurance policy or certificate delivered to an insured. The notice shall be in no less than 12-point font and shall state, "THIS (POLICY OR CERTIFICATE) IS NOT A MEDICARE SUPPLEMENT (POLICY OR CERTIFICATE). If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company."(b) An application for an accident and health insurance policy or certificate provided to an individual eligible for Medicare described in Subsection (3)(a) shall disclose, using the applicable statement in Subsection R590-146-3(3), the extent to which the policy duplicates Medicare. The disclosure statement shall be provided as a part of, or together with, the application for the policy or certificate.Utah Admin. Code R590-146-17
Amended by Utah State Bulletin Number 2019-13, effective 6/7/2019Adopted by Utah State Bulletin Number 2024-16, effective 8/7/2024