No individual Medicare supplement plan shall be delivered or issued in this state and no certificate shall be delivered under a group Medicare supplement plan delivered or issued in this state unless the plan is shown on the cover page and an outline containing at least the following information in no less than 12-point type is delivered to the applicant at the time the application is made:
(a) A description of the principal benefits and coverage provided in the policy;
(b) A statement of the exceptions, reductions, and limitations contained in the policy including the following language, as applicable, in bold print: "THIS POLICY DOES NOT COVER ALL MEDICAL EXPENSES BEYOND THOSE COVERED BY MEDICARE. THIS POLICY DOES NOT COVER ALL SKILLED NURSING HOME CARE EXPENSES AND DOES NOT COVER CUSTODIAL OR RESIDENTIAL NURSING CARE. READ YOUR POLICY CAREFULLY TO DETERMINE WHICH NURSING HOME FACILITIES AND EXPENSES ARE COVERED BY YOUR POLICY.";
(c) A statement of the renewal provisions including any reservations by the insurer of a right to change premiums. The premium and manner of payment shall be stated for all plans that are offered to the prospective applicant. All possible premiums for the prospective applicant shall be illustrated;
(d) Read your policy or certificate very carefully. A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions. Additionally, it does not give all the details of Medicare coverage. Contact your local Social Security office or consult the Medicare handbook for more details;
(e) A statement of the policy's loss ratio as follows: "This policy provides an anticipated loss ratio of (..%). This means that, on the average, policyholders may expect that ($....) of every $100.00 in premium will be returned as benefits to policyholders over the life of the contract.";
(f) When the outline of coverage is provided at the time of application and the Medicare supplement policy or certificate is issued on a basis that 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 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.";
(g) Right to return policy or certificate. "If you find that you are not satisfied with your policy or certificate for any reason, you may return it to (insert issuer's address). If you send the policy or certificate back to us within 30 days after you receive it, we will treat the policy or certificate as if it had never been issued and return all of your payments within ten days.";
(h) Policy or certificate replacement. "If you are replacing another health insurance policy or certificate, do NOT cancel it until you have actually received your new policy or certificate and are sure you want to keep it.";
(i) Notice. "This policy or certificate may not fully cover all of your medical costs."
A. (for agents:)
"Neither (insert company's name) nor its agents are connected with Medicare."
B. (for direct response:)
"(insert company's name) is not connected with Medicare."
(j) Notice regarding policies or certificates which are not Medicare supplement policies.
Any accident and sickness insurance policy or certificate, other than a Medicare supplement policy, or a policy or certificate issued pursuant to a contract under the federal Social Security Act, section 1833 or 1876 (United States Code, title 42, section 1395, et seq.), disability income policy; or other policy, 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 or certificate delivered to insureds. The notice shall be in no less than 12-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."
(k) Complete answers are very important. "When you fill out the application for the new policy or certificate, be sure to answer truthfully and completely all questions about your medical and health history. The company may cancel your policy or certificate and refuse to pay any claims if you leave out or falsify important medical information." If the policy or certificate is guaranteed issue, this paragraph need not appear.
"Review the application carefully before you sign it. Be certain that all information has been properly recorded."
Include for each plan, prominently identified in the cover page, a chart showing the services, Medicare payments, plan payments, and insured payments for each plan, using the same language, in the same order, using uniform layout and format.
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 benefit plan offered by the insurer.
1981 c 318 s 9; 1983 c 263 s 11; 1992 c 554 art 1 s 10; 1993 c 330 s 8; 1996 c 446 art 1 s 34
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62A — Accident And Health Insurance
Section 62A.011 — Definitions.
Section 62A.02 — Policy Forms.
Section 62A.021 — Health Care Policy Rates.
Section 62A.023 — Notice Of Rate Change.
Section 62A.024 — Explanations Of Rate Increases; Attribution To Statutory Changes.
Section 62A.03 — General Provisions Of Policy.
Section 62A.04 — Standard Provisions.
Section 62A.041 — Maternity Benefits.
Section 62A.0411 — Maternity Care.
Section 62A.042 — Family Coverage; Coverage Of Newborn Infants.
Section 62A.043 — Dental And Podiatric Coverage.
Section 62A.044 — Payments To Governmental Institutions.
Section 62A.045 — Payments On Behalf Of Enrollees In Government Health Programs.
Section 62A.046 — Coordination Of Benefits.
Section 62A.047 — Children's Health Supervision Services And Prenatal Care Services.
Section 62A.048 — Dependent Coverage.
Section 62A.049 — Limitation On Preauthorizations; Emergencies.
Section 62A.05 — Construction Of Provisions.
Section 62A.06 — Statements In Application.
Section 62A.07 — Rights Of Insurer, When Not Waived.
Section 62A.08 — Coverage Of Policy, Continuance In Force.
Section 62A.081 — Payments To Facilities Operated By State Or Local Government.
Section 62A.082 — Nondiscrimination In Access To Transplants.
Section 62A.095 — Subrogation Clauses Regulated.
Section 62A.096 — Notice To Insurer Of Subrogation Claim Required.
Section 62A.10 — Group Insurance.
Section 62A.105 — Coverages; Transfers To Substantially Similar Products.
Section 62A.11 — Blanket Accident And Sickness Insurance.
Section 62A.13 — Commercial Traveler Insurance Companies.
Section 62A.135 — Fixed Indemnity Policies; Minimum Loss Ratios.
Section 62A.136 — Hearing, Dental, And Vision Plan Coverage.
Section 62A.14 — Disabled Children.
Section 62A.141 — Coverage For Disabled Dependents.
Section 62A.145 — Survivor; Definition.
Section 62A.146 — Continuation Of Benefits To Survivors.
Section 62A.147 — Disabled Employees' Benefits; Definitions.
Section 62A.148 — Group Insurance; Provision Of Benefits For Disabled Employees.
Section 62A.149 — Benefits For Alcoholics And Drug Dependents.
Section 62A.15 — Coverage Of Certain Licensed Health Professional Services.
Section 62A.151 — Health Insurance Benefits For Emotionally Disabled Children.
Section 62A.152 — Benefits For Ambulatory Mental Health Services.
Section 62A.153 — Outpatient Medical And Surgical Services.
Section 62A.154 — Benefits For Des Related Conditions.
Section 62A.155 — Coverage For Services Provided To Ventilator-dependent Persons.
Section 62A.16 — Scope Of Certain Continuation And Conversion Requirements.
Section 62A.17 — Termination Of Or Layoff From Employment; Continuation And Conversion Rights.
Section 62A.18 — Prohibition Against Disability Offsets.
Section 62A.19 — Prohibition Against Nondiagnostic X-rays.
Section 62A.20 — Continuation Coverage Of Current Spouse And Children.
Section 62A.21 — Continuation And Conversion Privileges For Insured Former Spouses And Children.
Section 62A.22 — Refusal To Provide Coverage Because Of Option Under Workers' Compensation.
Section 62A.23 — Group Disability Income Coverage; Termination Without Prejudice; Definitions.
Section 62A.24 — Continuation Of Benefits.
Section 62A.25 — Reconstructive Surgery.
Section 62A.26 — Coverage For Phenylketonuria Treatment.
Section 62A.265 — Coverage For Lyme Disease.
Section 62A.27 — Coverage Of Adopted Children.
Section 62A.28 — Coverage For Scalp Hair Prostheses.
Section 62A.285 — Prohibited Underwriting; Breast Implants.
Section 62A.29 — Surety Bond Or Security For Certain Health Benefit Plans.
Section 62A.30 — Coverage For Diagnostic Procedures For Cancer.
Section 62A.302 — Coverage Of Dependents.
Section 62A.3021 — Coverage Of Dependents By Plans Other Than Health Plans.
Section 62A.303 — Prohibition; Severing Of Groups.
Section 62A.304 — Coverage For Port-wine Stain Elimination.
Section 62A.305 — Fibrocystic Condition; Termination Or Reduction Of Coverage.
Section 62A.306 — Use Of Gender Prohibited.
Section 62A.307 — Prescription Drugs; Equal Treatment Of Prescribers.
Section 62A.3075 — Cancer Chemotherapy Treatment Coverage.
Section 62A.308 — Hospitalization And Anesthesia For Dental Procedures.
Section 62A.3091 — Nondiscriminate Coverage Of Tests.
Section 62A.3092 — Equal Treatment Of Surgical First Assisting Services.
Section 62A.3093 — Coverage For Diabetes.
Section 62A.3094 — Coverage For Autism Spectrum Disorders.
Section 62A.3095 — Prescription Eye Drops Coverage.
Section 62A.3099 — Definitions.
Section 62A.31 — Medicare Supplement Benefits; Minimum Standards.
Section 62A.315 — Extended Basic Medicare Supplement Plan; Coverage.
Section 62A.316 — Basic Medicare Supplement Plan; Coverage.
Section 62A.3161 — Medicare Supplement Plan With 50 Percent Coverage.
Section 62A.3162 — Medicare Supplement Plan With 75 Percent Coverage.
Section 62A.3163 — Medicare Supplement Plan With 50 Percent Part A Deductible Coverage.
Section 62A.3164 — Medicare Supplement Plan With $20 And $50 Co-payment Medicare Part B Coverage.
Section 62A.3165 — Medicare Supplement Plan With High Deductible Coverage.
Section 62A.317 — Standards For Claims Payment.
Section 62A.318 — Medicare Select Policies And Certificates.
Section 62A.36 — Loss Ratio Standards.
Section 62A.37 — Government Certifications, Approvals, And Endorsements.
Section 62A.38 — Notice Of Free Examination.
Section 62A.40 — Replacement Regulated.
Section 62A.42 — Rulemaking Authority.
Section 62A.421 — Demonstration Projects.
Section 62A.43 — Limitations On Sales.
Section 62A.436 — Commissions.
Section 62A.44 — Applications.
Section 62A.451 — Definitions.
Section 62A.4511 — Certificate Of Authority Required.
Section 62A.4512 — Application For Certificate Of Authority.
Section 62A.4513 — Issuance Of Certificate Of Authority; Denial.
Section 62A.4514 — Filing Requirements For Authorized Entities.
Section 62A.4515 — Material Modifications.
Section 62A.4516 — Evidence Of Coverage.
Section 62A.4517 — Construction With Other Laws.
Section 62A.4518 — Nonduplication Of Coverage.
Section 62A.4519 — Complaint System.
Section 62A.4520 — Examination Of Organization.
Section 62A.4521 — Investments.
Section 62A.4523 — Protection Against Insolvency; Deposit.
Section 62A.4524 — Officer's And Employee's Fidelity Bond.
Section 62A.4526 — Suspension Or Revocation Of Certificate Of Authority.
Section 62A.4528 — Rehabilitation, Conservation, Or Liquidation.
Section 62A.48 — Long-term Care Policies.
Section 62A.49 — Home Care Services Coverage.
Section 62A.50 — Disclosures And Representations.
Section 62A.52 — Review Of Plan Of Care.
Section 62A.54 — Prohibited Practices.
Section 62A.60 — Retroactive Denial Of Expenses.
Section 62A.616 — Coverage For Nursing Home Care For Terminally Ill And Other Services.
Section 62A.62 — Demonstration Project.
Section 62A.64 — Health Insurance; Prohibited Agreements.
Section 62A.65 — Individual Market Regulation.
Section 62A.673 — Coverage Of Services Provided Through Telehealth.