Disclosure (Medicare Supplement Insurance) ****
This section will remind us of two things that have previously been discussed in detail - the Buyer's Guide and the Outline of Coverage. Here is a review.Buyer's Guide *****
Delivery of a Buyer's Guide must be made at the time of application. The guide is generic, so the buyer's guide tells the customer why someone would bother having that coverage at all.
Outline of coverage (Medicare supplements) *****
An outline of coverage must be delivered to the applicant at the time of application, and the applicant has to sign a receipt that they received it. A policy that is not a Medicare supplement must say as much on the front of the outline of coverage with the following language:
"This policy IS NOT A MEDICARE SUPPLEMENT policy. If you are eligible for Medicare, review the Medicare Supplement Buyer's Gide available from the company."
Replacement/replacement forms
Replacements happen every day (especially in health insurance) and there is nothing wrong with doing one as along as it's appropriate. To recap, the agent must do the following to make sure it is good for the customer:
- a Notice Regarding Replacement is given to the individual and a copy to the insurer.,
- a signed comparison statement (also called a Comparative Information Form) is given to the customer if requested, and
- notification to the current insurer, whether it is the agent's insurance company or another.
With regard to Medicare supplement replacements, there are certain specific rules that must be followed:
- Application forms must include statements and questions designed to determine if the applicant currently has coverage so the insurance company knows a replacement is happening.
- Within five working days from the receipt of an application, the replacing insurer must furnish a copy of the notice regarding replacement to the existing insurer whose policy is being replaced.
- All waiting periods, elimination periods and probationary periods that were satisfied in the original coverage would not be allowed to start over in the new coverage and so would be waived by the new insurer.
Duplication of benefits *****
No Medicare supplement policy may contain benefits that duplicate benefits provided by Medicare.
Standardized policy benefits (A-N)
The following standards are applicable to all 2010 Standardized Medicare supplement policies issued in Florida with an effective date for coverage on or after June 1, 2010.
Note: Specific coverages by plan are discussed in chapter 21.
- Medicare supplement policies must be guaranteed renewable.
- A Medicare supplement policy must not pay claims resulting from sickness on a different basis than those resulting from accidents.
- A Medicare supplement benefits must automatically follow any changes to the Medicare amounts they cover and premiums may be modified to reflect those changes.
- A Medicare supplement policy with benefits for prescription drugs in existence prior to January 1, 2006, may be renewed for current policyholders who do not enroll in Part D at the option of the policyholder.
New Medicare supplements issued after December 31, 2005 are not allowed to cover prescription drugs.
