Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act
Section 71.13 - Required Disclosure Provisions
Current through Register 1531, September 27, 2024
(1) General Rules.
"NOTICE: Read this outline of coverage summary carefully. It is not identical to the summary provided upon application and the coverage originally applied for has not been issued."
(2) Disclosure Standards.
MASSACHUSETTS MEDICARE SUPPLEMENT INSURANCE OUTLINE OF COVERAGE
(ISSUER'S NAME)
(Issuer's Policy Name and Number)
Policy Category: MEDICARE SUPPLEMENT INSURANCE
"NOTICE TO BUYER: This Policy may not cover all of the costs associated with medical care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all Policy limitations."
PREMIUM INFORMATION
We [insert Issuer' s name] can only raise your premium if we raise the premium for all Policies like yours in Massachusetts, and if approved by the Commissioner of Insurance. If you choose to pay your premium on a quarterly, semiannual, or annual basis, upon your death, we will refund the unearned portion of the premium paid. If you choose to pay your premium on a quarterly, semiannual, or annual basis and you cancel your Policy, we [insert either will or will not] refund the unearned portion of the premium paid. In the case of death [insert if the unearned portion of the premium will be refunded if coverage is canceled: or your cancellation of the Policy] the unearned portion of the premium will be refunded [insert on a pro rata basis or insert methodology which has been submitted to and approved by the Commissioner].
DISCLOSURES
Use this outline to compare benefits and premiums among Policies.
READ YOUR POLICY VERY CAREFULLY
This is only an outline describing your Policy's most important features. The Policy is your insurance contract. You must read the Policy itself to understand all of the rights and duties of both you and your insurance company.
RIGHT TO RETURN POLICY
If you find that you are not satisfied with your Policy, you may return it to [insert Issuer's address]. If you send the Policy back to us within 30 days after you receive it, we will treat the Policy as if it had never been issued and return all of your payments.
POLICY REPLACEMENT
If you are replacing another health insurance Policy, do NOT cancel it until you have actually received your new Policy and are sure you want to keep it. If you cancel your present Policy and then decide that you do not want to keep your new Policy, it may not be possible to get back the coverage of the present Policy.
If you newly enroll in a Medicare Supplement 1 plan and you became Medicare Eligible before January 1, 2020, you will not be able to switch into the same company's Medicare Supplement 1A plan until you have been covered under the Medicare Supplement 1 plan for a period of at least 12 months.
NOTICE
This Policy may not fully cover all of your medical costs.
[for agents:]
Neither [insert company's name] nor its agents are connected with Medicare.
[for direct response:]
[insert company' s name] is not connected with Medicare.
This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare & You for more details.
COMPLETE ANSWERS ARE VERY IMPORTANT
When you fill out the application for the new Policy, be sure to answer truthfully and completely all questions. The company may cancel your Policy and refuse to pay any claims if you leave out or falsify important information.
Review the application carefully before you sign it. Be certain that all information has been properly recorded.
[The term "Certificate" should be substituted for the word "Policy" throughout the outline of coverage where appropriate.]
[The Medicare Supplement outline of coverage shall include the following statement, entitled Massachusetts Summary. The provision concerning "Complaints" must be set forth in a separate paragraph.]
MASSACHUSETTS SUMMARY
The Commissioner of Insurance has set standards for the sale of Medicare Supplement Insurance Policies. Such Policies help you pay hospital and doctor bills, and some other bills, that are not covered in full by Medicare. Please note that the benefits provided by Medicare and this Medicare Supplement Insurance Policy may not cover all of the costs associated with your treatment. It is important that you become familiar with the benefits provided by Medicare and your Medicare Supplement Insurance Policy. This Policy summary outlines the different coverages you have if, in addition to this Policy, you are also covered by Part A (hospital bills, mainly) and Part B (doctors' bills, mainly) of Medicare.
Under M.G.L. c. 112, § 2, no physician who agrees to treat a Medicare beneficiary may charge to or collect from that beneficiary any amount in excess of the reasonable charge for that service as determined by the United States Secretary of Health and Human Services. This prohibition is commonly referred to as the ban on balance billing. A physician is allowed to charge you or collect from your insurer a copayment or coinsurance for Medicare-covered services. However, if your physician charges you or attempts to collect from you an amount which together with your copayment or coinsurance is greater than the Medicare-approved amount, please contact the Board of Registration in Medicine at [insert the telephone number for the Massachusetts Board of Registration in Medicine regarding licensing].
We cannot explain everything here. Massachusetts law requires that personal insurance Policies be written in easy-to-read language. So, if you have questions about your coverage not answered here, read your Policy. If you still have questions, ask your agent or company. You may also wish to get a copy of Medicare & You, a small book put out by Medicare that describes Medicare benefits.
THE BENEFITS TO PREMIUM RATIO FOR EACH POLICY SOLD is ___%.
[Insert here the lifetime aggregate anticipated loss ratio from 211 CMR 71.12(10)(a). If the ratio is different for different Policy forms, then separately specify the ratio for each Policy form. Heading should be in Boldface type.]
This means that during the anticipated life of your Policy and others just like it, the company expects to pay out $ _______ in claims made by you and all other Policyholders for every $100 it collects in premiums. The minimum ratio allowed for Policies of this type is ___%. A higher ratio is to your advantage as long as it allows the company a reasonable return so that the product remains available.
[If the ratio is different for different Policy forms, then provide a separate paragraph for each Policy form.]
COMPLAINTS
If you have a complaint, call us at [area code and telephone number] or your agent. If you are not satisfied, you may write or call the Massachusetts Division of Insurance, [insert the address of the Massachusetts Division of Insurance] or call [insert the telephone number of the consumer helpline at the Massachusetts Division of Insurance].
[Insert here a comparison of the benefits available under Medicare A and B, and the three Medicare Supplement Insurance Policies in the form prescribed by the Commissioner.]
"THIS [POLICY OR CERTIFICATE ] IS NOT A MEDICARE SUPPLEMENT [POLICY OR CONTRACT]. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company."
(3) MMA Notice Requirement. Issuers shall comply with any notice requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.