CHAPTER 13. MEDICARE SUPPLEMENT INSURANCE SOLICITATIONS
IC 27-8-13
Chapter 13. Medicare Supplement Insurance Solicitations
IC 27-8-13-1
"Medicare" defined
Sec. 1. As used in this chapter, "medicare" means Title XVIII ofthe federal Social Security Act (42 U.S.C. 1395 et seq.).
As added by P.L.275-1987, SEC.2.
IC 27-8-13-2
"Medicare supplement insurance solicitation" defined
Sec. 2. As used in this chapter, "Medicare supplement insurancesolicitation" means a meeting between an insurance producer andanother individual at which the insurance producer discusses thepossible issuance of a medicare supplement policy to the otherindividual.
As added by P.L.275-1987, SEC.2. Amended by P.L.178-2003,SEC.69.
IC 27-8-13-3
"Medicare supplement policy" defined
Sec. 3. (a) As used in this chapter, "Medicare supplement policy"means a group or individual policy of accident and sicknessinsurance or a subscriber contract of health maintenanceorganizations that is advertised, marketed, or designed primarily asa supplement to reimbursements under Medicare for the hospital,medical, or surgical expenses of persons eligible for Medicarebenefits.
(b) The term does not include a group policy issued:
(1) to or for the benefit of employees;
(2) to one (1) or more labor organizations; or
(3) to the trustees of a fund established:
(A) by one (1) or more employees or former employees; or
(B) for members or former members of a labor organization.
(c) The term does not include:
(1) a policy issued under a contract under Section 1876 or 1833of the federal Social Security Act (42 U.S.C. 1395 et seq.); or
(2) a policy issued under a demonstration project authorizedunder amendments to the federal Social Security Act.
As added by P.L.275-1987, SEC.2. Amended by P.L.255-1989,SEC.1; P.L.126-1992, SEC.1.
IC 27-8-13-4
Receipt for materials received by soliciting insurance producer;"materials" defined
Sec. 4. (a) Following a Medicare supplement insurancesolicitation, an insurance producer shall give the individual involvedin the solicitation a receipt for materials received by the insuranceproducer as a result of the solicitation.
(b) The receipt required under subsection (a) must be dated and
signed by the insurance producer and must set forth the following:
(1) An itemized list of the materials received by the insuranceproducer.
(2) The insurance producer's name.
(3) The address and telephone number of the insuranceproducer's office.
(c) As used in this section, "materials" includes any:
(1) document;
(2) cash;
(3) money order; or
(4) check or draft;
received by the insurance producer. The term does not include anapplication for a policy.
As added by P.L.275-1987, SEC.2. Amended by P.L.178-2003,SEC.70.
IC 27-8-13-5
"Applicant" defined
Sec. 5. As used in this chapter, "applicant" means:
(1) in the case of an individual Medicare supplement policy, theperson who seeks to contract for insurance benefits; and
(2) in the case of a group Medicare supplement policy, theproposed certificate holder.
As added by P.L.255-1989, SEC.2. Amended by P.L.126-1992,SEC.2.
IC 27-8-13-6
"Certificate" defined
Sec. 6. As used in this chapter, "certificate" means a certificate:
(1) issued under a group Medicare supplement policy; and
(2) delivered or issued for delivery in Indiana.
As added by P.L.255-1989, SEC.3.
IC 27-8-13-6.2
"Certificate form" defined
Sec. 6.2. As used in this chapter, "certificate form" means theform on which a certificate is delivered or issued for delivery by theissuer.
As added by P.L.126-1992, SEC.3.
IC 27-8-13-7
Repealed
(Repealed by P.L.126-1992, SEC.17.)
IC 27-8-13-7.3
"Issuer" defined
Sec. 7.3. As used in this chapter, "issuer" includes:
(1) an insurance company;
(2) a fraternal benefit society;
(3) a health care service plan; (4) a health maintenance organization; and
(5) any other entity;
that delivers a Medicare supplement policy or certificate in Indianaor issues a Medicare supplement policy or certificate for delivery inIndiana.
As added by P.L.126-1992, SEC.4.
IC 27-8-13-7.6
"Policy form" defined
Sec. 7.6. As used in this chapter, "policy form" means the form onwhich a policy is delivered or issued for delivery by the issuer.
As added by P.L.126-1992, SEC.5.
IC 27-8-13-8
Application of chapter
Sec. 8. (a) Except as otherwise specifically provided, this chapterapplies to the following:
(1) All Medicare supplement policies delivered or issued fordelivery in Indiana on or after June 1, 1989.
(2) All certificates issued under group Medicare supplementpolicies that have been delivered or issued for delivery inIndiana.
(b) This chapter does not apply to insurance policies or healthcare benefit plans, including group conversion policies, provided toMedicare eligible persons that are not marketed or held to beMedicare supplement policies or benefit plans.
As added by P.L.255-1989, SEC.5. Amended by P.L.126-1992,SEC.6.
IC 27-8-13-9
Medicare supplement policies; standards; preexisting medicalconditions
Sec. 9. (a) A Medicare supplement policy, contract, or certificatein force in Indiana may not contain benefits that duplicate benefitsprovided by Medicare. However, a change in Medicare coverage thatbecomes effective after a Medicare supplement policy, contract, orcertificate is in force in Indiana and that causes a duplication ofbenefits does not void the policy, contract, or certificate.
(b) The commissioner shall adopt rules under IC 4-22-2 toestablish specific standards for policy provisions of Medicaresupplement policies and certificates. Such standards shall be inaddition to and in accordance with Indiana law. No requirement ofIC 27 relating to minimum required policy benefits other than theminimum standards contained in this chapter apply to Medicaresupplement policies and certificates. The standards may cover, butare not limited to:
(1) terms of renewability;
(2) initial and subsequent conditions of eligibility;
(3) nonduplication of coverage;
(4) probationary periods; (5) benefit limitations, exceptions, and reductions;
(6) elimination periods;
(7) requirements for replacement;
(8) recurrent conditions; and
(9) definitions of terms.
(c) The commissioner may adopt rules under IC 4-22-2 thatspecify prohibited policy provisions not specifically authorized bystatute that, in the opinion of the commissioner, are unjust, unfair, orunfairly discriminatory to a person insured or proposed to be insuredunder a Medicare supplement policy or certificate.
(d) Notwithstanding any other law, a Medicare supplement policyor certificate shall not exclude or limit benefits for a loss incurredmore than six (6) months after the effective date of the policybecause the loss involves a preexisting condition. The policy orcertificate shall not define a preexisting condition more restrictivelythan a condition for which medical advice was given or treatmentwas recommended by or received from a physician within six (6)months before the effective date of coverage.
As added by P.L.255-1989, SEC.6. Amended by P.L.126-1992,SEC.7.
IC 27-8-13-10
Medicare supplement policy and certificate standards; conformitywith federal law and regulations
Sec. 10. (a) The commissioner shall adopt rules under IC 4-22-2to establish minimum standards for:
(1) claims payment;
(2) marketing practices;
(3) compensation arrangements; and
(4) reporting practices;
for Medicare supplement policies and certificates.
(b) The commissioner may adopt rules under IC 4-22-2 that arenecessary to conform Medicare supplement policies and certificatesto the requirements of federal law and federal regulations. A ruleadopted under this subsection may do the following:
(1) Require refunds or credits if the policies or certificates donot meet loss ratio requirements.
(2) Establish a uniform methodology for calculating andreporting loss ratios.
(3) Assure public access to policies, premiums, and loss ratioinformation of issuers of Medicare supplement insurance.
(4) Establish a process for approving or disapproving policyforms and certificate forms and proposed premium increases.
(5) Establish a policy for holding public hearings beforeapproval of premium increases.
(6) Establish standards for Medicare Select policies andcertificates.
As added by P.L.255-1989, SEC.7. Amended by P.L.149-1990,SEC.5; P.L.195-1991, SEC.1; P.L.126-1992, SEC.8.
IC 27-8-13-10.1
Model Medicare supplement policy standards
Sec. 10.1. (a) The commissioner shall adopt rules under IC 4-22-2to establish standards for model Medicare supplement policies. Thestandards must include standards for benefits.
(b) An insurer may issue a Medicare supplement policy orcertificate in Indiana only if the policy or certificate is one (1) of themodel policies adopted by the department under subsection (a).
As added by P.L.195-1991, SEC.2. Amended by P.L.126-1992,SEC.9.
IC 27-8-13-11
Repealed
(Repealed by P.L.126-1992, SEC.17.)
IC 27-8-13-12
Reasonable benefits; loss ratio standards
Sec. 12. (a) Medicare supplement policies must return topolicyholders benefits that are reasonable in relation to the premiumcharged.
(b) The commissioner shall adopt rules under IC 4-22-2 toestablish minimum standards for loss ratios of Medicare supplementpolicies on the basis of incurred claims experience, or incurred healthcare expenses if coverage is provided by a health maintenanceorganization on a service rather than reimbursement basis, andearned premiums in accordance with accepted actuarial principlesand practices.
As added by P.L.255-1989, SEC.9. Amended by P.L.126-1992,SEC.10.
IC 27-8-13-13
Repealed
(Repealed by P.L.149-1990, SEC.6.)
IC 27-8-13-14
Outline of coverage; contents
Sec. 14. (a) In order to provide for full and fair disclosure in thesale of Medicare supplement policies, a Medicare supplement policyor certificate may not be delivered in Indiana unless an outline ofcoverage is delivered to the applicant at the time application is made.
(b) The commissioner shall prescribe by rule adopted underIC 4-22-2 the form and content of the outline of coverage required bysubsection (a). For purposes of this section, "form" means style,arrangements, and overall appearance, including such items as thesize, color, and prominence of type and arrangement of text andcaptions. The outline of coverage must include the following:
(1) A description of the principal benefits and coverageprovided in the policy.
(2) A statement of the renewal provisions, including areservation by the issuer of a right to change premiums, and a
disclosure of the existence of any automatic premium increasesbased on the policyholder's age.
(3) A statement that the outline of coverage is a summary of thepolicy issued or applied for and that the policy should beconsulted to determine governing contractual provisions.
As added by P.L.255-1989, SEC.11. Amended by P.L.126-1992,SEC.11.
IC 27-8-13-15
Informational brochures
Sec. 15. (a) The commissioner may prescribe by rule adoptedunder IC 4-22-2 a standard form and the contents of an informationalbrochure for persons eligible for Medicare that is intended toimprove the buyer's ability to select the most appropriate coverageand improve the buyer's understanding of Medicare.
(b) Except in the case of direct response insurance policies, thecommissioner may require by rule adopted under IC 4-22-2 that theinformation brochure be provided to a prospective insured eligiblefor Medicare concurrently with delivery of the outline of coveragerequired under section 14 of this chapter.
(c) With respect to direct response insurance policies, thecommissioner may require by rule adopted under IC 4-22-2 that theprescribed brochure be provided upon request to a prospectiveinsured eligible for Medicare, but not later than the time of policydelivery.
As added by P.L.255-1989, SEC.12. Amended by P.L.126-1992,SEC.12.
IC 27-8-13-16
Disclosures distinguishing Medicare supplement coverages fromaccident and sickness coverages
Sec. 16. (a) The commissioner may adopt rules under IC 4-22-2for captions or notice requirements that are determined to be in thepublic interest and designed to inform prospective insureds thatparticular insurance coverages are not Medicare supplementcoverages. The captions or notice requirements may apply to allaccident and sickness insurance policies sold to persons eligible forMedicare by reason of age, other than:
(1) Medicare supplement policies;
(2) disability income policies;
(3) basic, catastrophic, or major medical expense policies; and
(4) single premium, nonrenewable policies.
(b) The commissioner may also adopt rules under IC 4-22-2 togovern the full and fair disclosure of the information in connectionwith the replacement of accident and sickness policies, subscribercontracts, or certificates by persons eligible for Medicare.
As added by P.L.255-1989, SEC.13. Amended by P.L.126-1992,SEC.13.
IC 27-8-13-17 Return privilege notice; refund
Sec. 17. (a) Medicare supplement policies and certificates musthave a notice prominently printed on the first page of the policy orcertificate or attached to the first page stating in substance that theapplicant has the right to return the policy or certificate within thirty(30) days of delivery and to have the premium refunded if, afterexamination of the policy or certificate, the applicant is not satisfiedfor any reason.
(b) A refund made under this section shall be paid directly to theapplicant by the issuer in a timely manner.
As added by P.L.255-1989, SEC.14. Amended by P.L.126-1992,SEC.14.
IC 27-8-13-18
Review and approval of proposed advertisements
Sec. 18. Every issuer of Medicare supplement insurance policiesor certificates in Indiana shall provide a copy of any Medicaresupplement advertisement intended for use in Indiana whetherthrough written, radio, or television medium to the commissioner forreview or approval by the commissioner to the extent required underIndiana law.
As added by P.L.255-1989, SEC.15. Amended by P.L.126-1992,SEC.15.
IC 27-8-13-19
Penalties for noncompliance
Sec. 19. In addition to any other penalties for violations of IC 27,the commissioner may take either or both of the following actions:
(1) Require issuers violating this chapter or rules adopted underthis chapter to cease marketing a Medicare supplement policyor certificate in Indiana that is related directly or indirectly to aviolation.
(2) Require the issuer to take the action necessary to complywith this chapter.
As added by P.L.255-1989, SEC.16. Amended by P.L.126-1992,SEC.16.
IC 27-8-13-20
Refund of unused premiums
Sec. 20. (a) All Medicare supplement policies issued for deliveryin Indiana after June 30, 1990, must provide for the refund of unusedpremiums upon the death of the insured during the contract period.
(b) The amount of premium refund shall be prorated from the datefollowing the date of death of the insured to the end of the contractperiod for which the premium has been paid.
(c) The refund required by this section shall be paid as follows:
(1) If a person other than the insured paid the premium, to thatperson. A person entitled to a refund under this subdivisionmust provide proof of payment to the insurer.
(2) If the insured paid the premium, to the surviving spouse of
the insured. If there is no surviving spouse, the premium shallbe paid in the same manner as distributions of the net estate ofa person who dies intestate under IC 29-1-2-1(d).
(d) A person entitled to receive a refund under this section mustdo the following:
(1) Submit a written request for the refund.
(2) Furnish proof of the insured's death.
As added by P.L.151-1990, SEC.2.