26.1-36.1 Medicare Supplement Policies
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the person who seeks to contract for insurance benefits.b.In the case of a group medicare supplement policy or subscriber contract, the
proposed certificate holder.2."Certificate" means any certificate issued under a group medicare supplement policy
which has been delivered or issued for delivery in this state.3."Medicare" means the Health Insurance for the Aged and Disabled Act, title XVIII of
the Social Security Act of 1965 [Pub. L. 92-603; 86 Stat. 1370 et seq.], as amended.4."Medicare supplement policy" means a group or individual accident and health
insurance policy or a subscriber contract of a health service corporation or a health
care plan of a health maintenance organization or preferred provider organization,
other than a policy issued pursuant to a contract under section 1876 of the federal
Social Security Act [42 U.S.C. 1395 et seq.] or an issued policy under a
demonstration project specified in 42 U.S.C. 1395ss(g)(1), which is advertised,
marketed, or designed primarily as a supplement to reimbursements under
medicare for the hospital, medical, or surgical expenses of persons eligible for
medicare. The term does not include a policy or contract of one or more employers
or labor organizations, or of the trustees of a fund established by one or more
employers or labor organizations, or combination thereof, for employees or former
employees, or combination thereof, or for members or former members, or
combination thereof, of the labor organizations.26.1-36.1-02. Standards for medicare supplement policies.1.The commissioner shall adopt reasonable rules to establish specific standards for
provisions of medicare supplement policies. The standards are in addition to and in
accordance with applicable laws of this state, and may include coverage of:a.Terms of renewability.b.Initial and subsequent conditions of eligibility.c.Nonduplication of coverage.d.Probationary periods.e.Benefit limitations, exceptions, and reductions.f.Elimination periods.g.Requirements for replacement.h.Recurrent conditions.i.Definition of terms.Page No. 12.The commissioner may adopt rules that specify prohibited medicare supplement
policy provisions not otherwise specifically authorized by statute which, in the
opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any
person insured or proposed for coverage under a medicare supplement policy or
certificate.3.Notwithstanding any other law, a medicare supplement policy or certificate may not
deny a claim for losses incurred for more than six months from the effective date of
coverage for a preexisting condition.The policy or certificate may not define apreexisting condition more restrictively than a condition for which medical advice
was given or treatment was recommended by or received from a physician within six
months before the effective date of coverage.4.No medicare supplement insurance policy, contract, or certificate in force in the state
may contain benefits that duplicate benefits provided by medicare.26.1-36.1-03. Rulemaking authority. The commissioner may adopt rules to establishstandards for benefits, standard policies and optional benefit riders, claims payments, abusive
marketing practices and compensation arrangements, and reporting practices for medicare
supplement policies.26.1-36.1-04.Medicare supplement policy loss ratio standards.Medicaresupplement policies must return benefits to individual policyholders in the aggregate of not less
than sixty-five percent of premium received. The commissioner shall adopt rules to establish
minimum standards for medicare supplement policy loss ratios on the basis of incurred claims
experience and earned premiums for the entire period for which rates are computed to provide
coverage and in accordance with accepted actuarial principles and practices.26.1-36.1-05. Medicare supplement policy disclosure standards.1.To provide for full and fair disclosure in the sale of medicare supplement policies, no
medicare supplement policy or certificate may be delivered or issued for delivery in
this state unless an outline of coverage is delivered to the applicant at the time
application is made.2.The commissioner shall prescribe the format and content of the outline of coverage
required by subsection 1.For purposes of this section, "format" means style,arrangement, and overall appearance, including such items as the size, color, and
prominence of type and the arrangement of text and captions.The outline ofcoverage must include: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.c.A statement of the renewal provisions, including any reservation by the insurer
of a right to change premiums.d.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.3.The commissioner may prescribe by rule a standard form and the contents of an
informational brochure for persons eligible for medicare which is intended to improve
the buyer's ability to select the most appropriate coverage and improve the buyer's
understanding of medicare.Except in the case of direct response insurancepolicies, the commissioner may require by rule that the information brochure be
provided to any prospective insureds eligible for medicare concurrently with thePage No. 2delivery of the outline of coverage.With respect to direct response insurancepolicies, the commissioner may require by rule that the prescribed brochure be
provided upon request to any prospective insureds eligible for medicare, but in no
event later than the time of policy delivery.4.The commissioner may adopt rules for captions or notice requirements, determined
to be in the public interest and designed to inform prospective insureds that
particular insurance coverages are not medicare supplement coverages, for all
accident and health insurance policies sold to persons eligible for medicare, other
than:a.Medicare supplement policies; orb.Disability income policies.5.The commissioner may also adopt rules to govern the full and fair disclosure of the
information in connection with the replacement of accident and sickness policies,
subscriber contracts, or certificates by persons eligible for medicare.26.1-36.1-06. Medicare supplement policies - Notice of free examination. Medicaresupplement policies or certificates must have a notice prominently printed on or attached to the
first page of the policy stating in substance that the applicant may return the policy or certificate
within thirty days of its delivery and have the premium refunded if, after examination of the policy
or certificate, the applicant is not satisfied for any reason.26.1-36.1-07. Filing requirements for advertising. Every insurer, health care serviceplan, or other entity providing medicare supplement insurance or benefits in this state shall
provide a copy of any medicare supplement advertisement within ten days after its first use in
this state whether through written, radio, or television medium for review or approval by the
commissioner to the extent required or authorized by state law.26.1-36.1-08. Effect of policy not conforming to chapter. A policy delivered or issuedfor delivery to any person in this state in violation of this chapter is valid but must be construed as
provided in this chapter. When any provision in a policy subject to this chapter is in conflict with
this chapter, the rights, duties, and obligations of the insurer, the insured, and the beneficiary are
governed by this chapter.26.1-36.1-09.General penalty - License suspension or revocation.Any personwillfully violating any provision of this chapter or order of the commissioner made in accordance
with this chapter is guilty of a class A misdemeanor. The commissioner may also suspend or
revoke the license of an insurer or insurance producer for any such willful violation.Page No. 3Document Outlinechapter 26.1-36.1 medicare supplement policies