(a) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant upon request, but no later than when the agent first discusses the policy’s provisions or limits of coverage with the applicant. In the case of direct response solicitation, the insurer shall include the outline of coverage when an application is distributed to the potential buyer.
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Terms Used In Tennessee Code 56-7-1505

  • Applicant: means :
    (A) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits. See Tennessee Code 56-7-1501
  • Certificate: means , any certificate delivered or issued for delivery in this state under a group medicare supplement policy. See Tennessee Code 56-7-1501
  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
  • Issuer: includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state medicare supplement policies or certificates. See Tennessee Code 56-7-1501
  • Medicare: means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965. See Tennessee Code 56-7-1501
  • Medicare supplement policy: means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations other than a policy issued pursuant to a contract under §. See Tennessee Code 56-7-1501
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
(b) The commissioner shall by rule or regulation prescribe the format and content of the outline of coverage required by subsection (a). For purposes of this section, “format” means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include:

(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums, and disclosure of the existence of any automatic renewal premium increases based on the policyholder’s age; and
(3) 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.
(c) The commissioner shall prescribe by rule or regulation 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 insurance policies, the commissioner may require by regulation that the informational brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the commissioner may require by regulation 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.
(d) The commissioner shall promulgate rules and regulations 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 sickness insurance policies sold to persons eligible for medicare other than:

(1) Medicare supplement policies; or
(2) Disability income policies.
(e) The commissioner shall promulgate reasonable rules and regulations 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.
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