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OAC 365:10



Issuers of accident and health policies or certificates which provide hospital or












a person(s) eligible

for Medicare Medicare in

shall the

provide to those applicants a form developed jointly by

Guide to Health Insurance for People with the National Association of Insurance


Commissioners and the CMS and in a type size no smaller than 12 point type. Delivery of the Guide shall be made whether or not such policies or certificates are advertised, solicited or issued as Medicare supplement policies or certificates as defined in this Part. Except in the case of direct response issuers, delivery of the Guide shall be made to the applicant at the time of application and acknowledgement of receipt of the Guide shall be obtained by the issuer. Direct response issuers shall deliver the Guide to the applicant upon request but not later than at the time the policy is delivered. For purposes of this section, "form" means the language, format, type size, type proportional spacing, bold character, and line spacing. Notice requirements. (1) As soon as practicable, but no later than thirty (30) days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its policyholders and certificateholders of modifications it has made to Medicare supplement insurance policies or

certificates in a format acceptable to the Commissioner. Such notice shall:

    • (A)

      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

    • (B)

      Inform each policyholder or certificateholder as to when any premium adjustment is to be made due to changes in Medicare.

  • (2)

    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.


Such notices shall not contain or be accompanied by any solicitation.


MMA notice requirements. Issuers shall comply with any notice requirements of the Medicare Prescription Drug,

Improvement and Modernization Act of 2003.

  • (d)

    Outline of coverage requirements for Medicare supplement policies.

    • (1)

      Issuers shall provide an outline of coverage to all applicants at the time application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgement of receipt of such outline from the applicant.

    • (2)

      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 such policy or certificate when it is delivered and contain the following statement, in no less than twelve (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."

    • (3)

      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 issuer. The outline of coverage shall be in the language and format prescribed in the most recent edition of the National Association of

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