Michigan Laws 500.3835 – Marketing procedures; determining appropriateness of recommended purchase or replacement; more than 1 policy prohibited; individual enrolled in medicare advantage; “notice to buyer” displayed
Current as of: 2024 | Check for updates
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Terms Used In Michigan Laws 500.3835
- Applicant: means :
(i) For an individual Medicare supplement policy, the person who seeks to contract for benefits. See Michigan Laws 500.3801Certificate: means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy. See Michigan Laws 500.3801 Contract: A legal written agreement that becomes binding when signed. Insurer: includes any person that delivers or issues for delivery in this state Medicare supplement policies. See Michigan Laws 500.3801 Medicare: means subchapter XVIII of the social security act, 42 USC 1395 to 1395lll. See Michigan Laws 500.3801 Medicare advantage: means a plan of coverage for health benefits under Medicare part C as described in 42 USC 1395w-28, and includes any of the following:
(i) Coordinated care plans that provide health care services, including, but not limited to, health maintenance organization plans with or without a point-of-service option, plans offered by provider-sponsored organizations, and preferred provider organization plans. See Michigan Laws 500.3801Medicare supplement policy: means an individual or group policy or certificate that 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 and Medicare select policies and certificates under section 3817. See Michigan Laws 500.3801 state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
(1) An insurer that markets Medicare supplement insurance coverage in this state directly or through its agents shall do all of the following:
(a) Establish marketing procedures to ensure that any comparison of policies by its agents will be fair and accurate.
(b) Establish marketing procedures to ensure excessive insurance is not sold or issued.
(c) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant for Medicare supplement insurance already has health coverage.
(d) Establish auditable procedures for verifying compliance with this subsection.
(2) In recommending the purchase or replacement of any Medicare supplement coverage, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.
(3) Any sale of Medicare supplement coverage that will provide an individual with more than 1 Medicare supplement policy, certificate, or contract is prohibited.
(4) An insurer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare advantage unless the effective date of the coverage is after the termination date of the individual’s Medicare advantage coverage.
(5) A medical supplement policy must display prominently by type, stamp, or other appropriate means, on the first page of the policy the following: “Notice to buyer: This policy may not cover all of your medical expenses.”.