Current through Pa Acts 2024-53, 2024-56 through 2024-111
Section 3107 - Required disclosure provisions(a) Each medicare supplement policy 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 certificate, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.(b) 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 such terms and an explanation of such terms in its accompanying outline of coverage.(c) If a medicare supplement policy contains any limitations with respect to preexisting conditions, such limitations shall appear as a separate paragraph of the certificate and be labeled as "Preexisting Condition Limitations."(d) Certificates, other than those issued pursuant to direct response solicitation, shall have a notice prominently printed on the first page of the certificate or attached thereto stating in substance that the certificate holder shall have the right to return the certificate within ten days of its delivery and to have the premium refunded if, after examination of the certificate, the insured person is not satisfied for any reason. Medicare supplement certificates 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 certificate holder shall have the right to return the certificate within 30 days of its delivery and to have the premium refunded if after examination the insured person is not satisfied for any reason.(e) Insurers issuing accident and health certificates under group policies delivered or issued for delivery in this Commonwealth which provide hospital or medical expense coverage on an expense incurred or indemnity basis other than incidentally, to a person eligible for medicare by reason of age, shall provide to the certificate holder a medicare supplement buyer's guide in the form consistent with the then current edition of the model jointly developed by the National Association of Insurance Commissioners and the Health Care Financing Administration of the United States Department of Health and Human Services. Delivery of the buyer's guide shall be made whether or not such group policy qualifies as a medicare supplement policy as defined in this act. 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 certification of delivery of the buyer's guide shall be provided to the insurer. Direct response insurers issuing medicare supplement policies shall deliver the buyer's guide upon request, but not later than at the time the certificate is delivered.(f) The terms "medicare supplement," "medigap" and words of similar import shall not be used unless the policy is issued in compliance with section 5. (g)(1) Insurers issuing medicare supplement policies subject to this act shall deliver an outline of coverage to the applicant at the time application is made and, except for the direct response policy, acknowledgment of receipt or certification of delivery of such outline of coverage shall be provided to the insurer.(2) If an outline of coverage was delivered at the time of application and the certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the certificate shall accompany such certificate when it is delivered and shall contain the following statement, in no less than 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 not been issued."(3) The outline of coverage required under this subsection shall be in a form consistent with the then current model adopted by the National Association of Insurance Commissioners and amended to reflect changes in the medicare program.1982, Dec. 15, P.L. 1291, No. 292, § 7, effective 7/1/1983.