HAR §16-12-8.3. Notice requirements

(a) As soon as practicable, but no later than thirty days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its policyholders and certificate holders of modifications it has made to Medicare supplement insurance policies or certificates in a format acceptable to the commissioner. The notice shall: (1) Include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement policy or certificate; and (2) Inform each policyholder or certificate holder as to when any premium adjustment is to be made due to changes in Medicare. (b) The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and simple terms so as to facilitate comprehension. (c) The notices shall not contain or be accompanied by any solicitation. §16-12-8.3 12-84 (d) Issuers shall comply with any notice requirements of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. [Eff and comp 10/28/89; am and comp 12/27/90; am and comp 9/3/92; am and comp 7/6/99; comp 10/15/01; comp 12/9/02; am and comp 10/8/05; comp 9/25/09; am and comp 8/1/19] (Auth: HRS §§431:2-201, 431:10A-304, 431:10A-305, 431:10A-307) (Imp: HRS §§431:2-201, 431:10A-305, 431:10A-307) §16-12-9 Outline of coverage requirements for Medicare supplement policies. (a) Issuers shall provide an outline of coverage to all applicants at the time the application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgment of receipt of the outline from the applicant. (b) If an outline of coverage is provided at the time of application and the Medicare supplement policy or certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or certificate shall accompany the policy or certificate when it is delivered and contain the following statement, in no less than twelve 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." (c) The outline of coverage provided to applicants pursuant to this section consists of four parts: a cover page, premium information, disclosure pages, and charts displaying the features of each §16-12-10 12-85 benefit plan offered by the issuer. The outline of coverage shall be in the language and format prescribed below in no less than twelve point type. All Plans A-L shall be shown on the cover page, and the plan(s) that are offered by the issuer shall be prominently identified. Premium information for plans that are offered shall be shown on the cover page or immediately following the cover page and shall be prominently displayed. The premium and mode shall be stated for all plans that are offered to the prospective applicant. All possible premiums for the prospective applicant shall be illustrated. (d) The outline of coverage provided to the applicant pursuant to subsections (a), (b), and (c) shall be in the form prescribed in Exhibit A (revised 2019), located at the end of this chapter, which is made a part of this section. [Eff 5/17/82; am and comp 10/28/89; am and comp 12/27/90; am and comp 9/3/92; am and comp 7/6/99; am and comp 10/15/01; comp 12/9/02; am and comp 10/8/05; comp 9/25/09; am and comp 8/1/19] (Auth: HRS §§431:2-201, 431:10A-304, 431:10A-305, 431:10A-307) (Imp: HRS §§431:2-201, 431:10A-305, 431:10A-307) §16-12-10 Notice regarding policies or certificates which are not Medicare supplement policies. (a) Any accident and sickness insurance policy or certificate other than a Medicare supplement policy, any policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act (42 U.S.C. Section 1395 et seq.), any disability income policy, or any other policy identified in subsection 16-12-2(b) of this chapter, issued for delivery in this State to persons eligible for Medicare shall notify insureds under the policy that the policy is not a Medicare supplement policy or certificate. The notice shall either be printed or attached to the first page of the outline of coverage delivered to insureds under the policy or, if no outline of coverage is delivered, to the first page of the policy §16-12-10 12-86 or certificate delivered to insureds. The notice shall be in no less than twelve point type and shall contain the following language: "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." (b) Applications provided to persons eligible for Medicare for the health insurance policies or certificates described in subsection 16-12-10(a) shall disclose, using the applicable statement in Appendix C (Exhibit F (revised 2019)), 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. [Eff 5/17/82; am and comp 10/28/89; am and comp 12/27/90; am and comp 9/3/92; am and comp 7/6/99; am and comp 10/15/01; comp 12/9/02; am and comp 10/8/05; am and comp 9/25/09; am and comp 8/1/19] (Auth: HRS §§431:2-201, 431:10A-304, 431:10A-305, 431:10A-307) (Imp: HRS §§431:2-201, 431:10A-305, 431:10A-307) §16-12-11 Requirements for application forms and replacement coverage. (a) Application forms shall include questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or other health insurance policy or certificate in force or whether a Medicare supplement policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent may be used containing the §16-12-11 12-87 questions and statements in substantially the form entitled Exhibit C (revised 2019), located at the end of this chapter, which is made a part of this section. (b) Agents shall list any other health insurance policies they have sold to the applicant. Agents shall: (1) List policies sold which are still in force; and (2) List policies sold in the past five years which are no longer in force. (c) In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant, and acknowledged by the insurer, shall be returned to the applicant by the insurer upon delivery of the policy. (d) Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer or its agent, shall furnish the applicant, prior to issuance or delivery of the Medicare supplement policy or certificate, a notice regarding replacement of Medicare supplement coverage. One copy of the notice signed by the applicant and the agent, except where the coverage is sold without an agent, shall be provided to the applicant and an additional signed copy shall be retained by the issuer. A direct response issuer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of Medicare supplement coverage. (e) The notice required by subsection (d) for an issuer, shall be provided in no less than twelve point type, in substantially the form entitled as Exhibit B (revised 2019), located at the end of this chapter, which is made a part of this section. (f) Paragraphs one and two of the replacement notice (applicable to preexisting conditions) in Exhibit B (revised 2019) may be deleted by an issuer if the replacement does not involve application of a new preexisting condition limitation. [Eff 5/17/82; am and comp 10/28/89; am and comp 12/27/90; am and comp 9/3/92; am and comp 7/6/99; am and comp 10/15/01; comp 12/9/02; am and comp 10/8/05; am and comp §16-12-11 12-88 9/25/09; am and comp 8/1/19] (Auth: HRS §§431:2-201, 431:10A-304, 431:10A-305, 431:10A-307) (Imp: HRS §§431:2-201, 431:10A-305, 431:10A-307)