D.C. Mun. Regs. tit. 26, r. 26-A2299

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 26-A2299 - DEFINITIONS

2299.1

For purposes of this chapter, the words and phrases set forth in this section shall have the meanings ascribed.

1990 Standardized Medicare supplement benefit plan, 1990 Standardized benefit plan, or 1990 plan means a group or individual policy of Medicare supplement insurance issued on or after May 1, 1999 and prior to June 1, 2010 and includes Medicare supplement insurance policies and certificates renewed on or after that date which are not replaced by the issuer at the request of the insured.

2010 Standardized Medicare supplement plan, 2010 Standardized benefit plan, or 2010 plan means a group or individual policy of Medicare supplement insurance issued on or after June 1, 2010.

Applicant - means:

(a) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and

(b) In the case of a group Medicare supplement policy, the proposed certificateholder.

Bankruptcy - means a Medicare Advantage organization which is not an issuer has filed, or has had filed against it, a petition for declaration of bankruptcy and has ceased doing business in the District.

Certificate - means any certificate delivered or issued for delivery in the District of Columbia under a group Medicare supplement policy.

Certificateform - means the form on which the certificate is delivered or issued for delivery by the issuer.

Continuous period of creditable coverage - means the period during which an individual was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than sixty-three (63) days.

Creditable coverage - means with respect to an individual, coverage of the individual provided under any of the following:

(a) A group health plan;

(b) Health insurance coverage;

(c) Part A or Part B of Title XVII of the Social Security Act (Medicare);

(d) Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under section 1928;

(e) Chapter 55 of Title 10 of the United States Code (CHAMPUS);

(f) A medical care program of the Indian Health Service or of a tribal organization;

(g) A District health benefits risk pool;

(h) A health plan offered under chapter 89 of Title 5 of the United States Code (Federal Employees Health Benefits Program);

(i) A public health plan as defined in federal regulation; and

(j) A health benefit plan under section 5(e) of the Peace Corps Act, 22 U.S.C. 2504(e).

Creditable coverage - means insurance coverage that does not include one or more, or any combination of, the following:

(a) Coverage only for accident or disability income insurance, or any combination thereof;

(b) Coverage issued as a supplement to liability insurance;

(c) Liability insurance, including general liability insurance and. automobile liability insurance;

(d) Workers' compensation or similar insurance;

(e) Automobile medical payment insurance;

(f) Credit-only insurance;

(g) Coverage for on-site medical clinics; and

(h) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

Creditable coverage - means insurance coverage that does not include the following if it is offered as a separate policy, certificate or contract of insurance:

(a) Medicare supplemental health insurance as defined under section 1882(g) (1) of the Social Security Act;

(b) Coverage supplemental to the coverage provided under chapter 55 of Title 10, United States Code; and

(c) Similar supplemental coverage provided to coverage under a group health plan.

District - means the District of Columbia.

Employer welfare benefit plan - means a plan, fund or program of employee benefits as defined in the Employee Retirement Income Security Act, 29 U.S.C. § 1002.

Insolvency - means an issuer, licensed to transact the business of insurance in the District, has had a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer's state of domicile.

Issuer - means an insurance company, fraternal benefit society, health care service plan, health maintenance organization, and any other entity delivering or issuing, for delivery in the District of Columbia, Medicare supplement policies or certificates.

Medicare - means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

Medicare Advantage plan - means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w - 28(b)(1), and includes:

(1) Coordinated care plans which 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;

(2) Medical savings account plans coupled with a contribution into a Medicare Advantage plan medical savings account; and

(3) Medicare Advantage private fee-for-service plans. Medicare supplement policy - means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical services associations or health maintenance organizations, other than a policy issued pursuant to a contract under Section 1876 of the Social Security Act 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. "Medicare supplement policy" does not include Medicare Advantage plans established under Medicare Part C, Outpatient Prescription Drug plans established under Medicare Part D, or any Health Care Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under § 1833(a)(1)(A) of the Social Security Act.

Policy form - means the form on which the policy is delivered or issued for delivery by the issuer.

Pre-Standardized Medicare supplement benefit plan, Pre-Standardized benefit plan, or Pre-Standardized plan means a group or individual policy of Medicare supplement insurance issued prior to May 1, 1999.

Secretary - means the Secretary of the United States Department of Health and Human Services.

APPENDIX A

MEDICARE SUPPLEMENT REFUND CALCULATION FORM

FOR CALENDAR YEAR

TYPE¹ ________	SMSBP² ________
For the State of ________	Company Name ________
NAIC Group Code ________	NAIC Company Exhibit ________
Address ________	Person Completing Exhibit ________
Title ________	Telephone Number ________

Line	(a) Earned Premium³	(b) Incurred Claims⁴
1.	Current Year's Experience
a. Total (all policy years)
b. Current year's issues5
c. Net (for reporting purposes = la - lb
2.	Past Years' Experience (all policy years)
3.	Total Experience (Net Current Year + Past Year)
4.	Refunds Last Year (Excluding Interest)
5.	Previous Since Inception (Excluding Interest)
6.	Refunds Since Inception (Excluding Interest)
7.	Benchmark Ratio Since Inception (see worksheet for Ratio 1)
8.	Experienced Ratio Since Inception (Ratio 2) Total Actual Incurred Claims (line 3, col. b) / Total Earned Prem. (line 3, col. a)-Refunds Since Inception (line 6)
9.	Life Years Exposed Since Inception If the Experienced Ratio is less than the Benchmark Ratio, and there are more than 500 life years exposure, then proceed to calculation of refund.
10.	Tolerance Permitted (obtained from credibility table)

Medicare Supplement Credibility Table

Life Years Exposed
Since Inception	Tolerance
10,000 +	0.0%
5,000 -9,999	5.0%
2,500 -4,999	7.5%
1,000 -2,499	10.0%
500 - 999	15.0%
If less than 500 no credibility.

1 Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

2 "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for prestandardized plans.

3 Includes Modal Loadings and Fees Charged

4 Excludes Active Life Reserves

5 This is to be used as "Issue Year Earned Premium" for Year 1 of next year's "Worksheet for Calculation of Benchmark Ratios"

MEDICARE SUPPLEMENT REFUND CALCULATION FORM

FOR CALENDAR YEAR

TYPE¹ _________	SMSBP² _________
For the State of _________	Company Name _________
NAIC Group Code _________	NAIC Company Code _________
Address _________	Person Completing Exhibit _________
Title _________	Telephone Number _________

11.	Adjustment to Incurred Claims for Credibility Ratio 3 = Ratio 2 + Tolerance

If Ratio 3 is more than Benchmark Ratio (Ratio 1), a refund or credit to premium is not required.

If Ratio 3 is less than the Benchmark Ratio, then proceed.

12.

Adjusted Incurred Claims

[Total Earned Premiums (line 3, col. a) - Refunds Since Inception (line 6)] x

Ratio 3 (line 11)

13.

Refund =

Total Earned Premiums (line 3, col. a)-Refunds Since Inception (line 6)

-[Adjusted Incurred Claims (line 12)/Benchmark Ratio (Ratio 1)]

If the amount on line 13 is less than 005 times the annualized premium in force as of December 31 of the reporting year, then no refund is made. Otherwise, the amount on line 13 is to be refunded or credited, and a description of the refund or credit against premiums to be used must be attached to this form.

I certify that the above information and calculations are true and accurate to the best of my knowledge and belief.

________________

Signature

________________

Name - Please Type

________________

Title - Please Type

________________

Date

REPORTING FORM FOR THE CALCULATION OF BENCHMARK

RATIO SINCE INCEPTION FOR GROUP POLICIES FOR CALENDAR YEAR

TYPE¹	SMSBP²
For the State of	Company Name
NAIC Group Code	NAIC Company Code
Address	Person Completing Exhibit
Title	Telephone Number

(a)³	(b)⁴	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(i)	(o)⁵
Year	Earned Premium	Factor	(b)x(c)	Cumulative Loss Ratio	(d)x(e)	Factor	(b)x(g)	Cumulative Loss Ratio	(h)x(i)	Policy Year Loss Ratio
1	2.770	0.507	0.000	0.000	0.46
2	4.175	0.567	0.000	0.000	0.63
3	4.175	0.567	1.194	0.759	0.75
4	4.175	0.567	2.245	0.771	0.77
5	4.175	0.567	3.170	0.782	0.80
6	4.175	0.567	3.998	0.792	0.82
7	4.175	0.567	4.754	0.802	0.84
8	4.175	0.567	5.445	0.811	0.87
9	4.175	0.567	6.075	0.818	0.88
10	4.175	0.567	6.650	0.824	0.88
11	4.175	0.567	7.176	0.828	0.88
12	4.175	0.567	7.655	0.831	0.88
13	4.175	0.567	8.093	0.834	0.89
14	4.175	0.567	8.493	0.837	0.89
15+⁶	4.175	0.567	8.684	0.838	0.89
Total:	(k):	(l):	(m):	(n):

Benchmark Ratio Since Inception: (1 + n)/(k + m):

¹ Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

² "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for pre-standardized plans

³ Year 1 is the current calendar year - 1. Year 2 is the current calendar year - 2 (etc.) (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

⁴ For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

⁵ These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

⁶ To include the earned premium for all years prior to as well as the 15^th year prior to the current year.

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR INDIVIDUAL POLICIES FOR CALENDAR YEAR

TYPE¹	SMSBP²
For the State-of	Company Name
NAIC Group Code	NAIC Company Code,
Address	Person Completing Exhibit
Title	Telephone Number

(a)³	(b)⁴	(c)	(d)	(e)	(1)	(g)	(i)	(i)	(i)	(o)⁵
Year	Earned Premium	Factor	(b)x(c)	Cumulative Loss Ratio	(d)x(e)	Factor	(b)x(g)	Cumulative Loss Ratio	(h)x(i)	Policy Year Loss Ratio
1	2.770	0.442	0.000	0.000	0.40
2	4.175	0.493	0.000	0.000	0.55
3	4.175	0.493	1.194	0.659	0.65
4	4.175	0.493	2.245	0.669	0.67
5	4.175	0.493	3.170	0.678	0.69
6	4.175	0.493	3.998	0.686	0.71
7	4.175	0.493	4.754	0.695	0.73
8	4.175	0.493	5.445	0.702	0.75
9	4.175	0.493	6.075	0.708	0.76
10	4.175	0.493	6.650	0.713	0.76
11	4.175	0.493	7.176	0.717	0.76
12	4.175	0.493	7.655	0.720	0.77
13	4.175	0.493	8.093	0.723	0.77
14	4.175	0.493	8.493	0.725	0.77
15+⁶	4.175	0.493	8.684	0.725	0.77
Total:	(k):	(l):	(m):	(n):

Benchmark Ratio Since Incept on: (1 + n)/(k + m):

¹ Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

² "SMSBP" = Standardized Medicare Supplement Benefit Plan. Use "P" for pre-standardized plans

³ Year 1 is the current calendar year - 1. Year 2 is the current calendar year - 2 (etc.) (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

⁴ For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

⁵These loss ratios are not explicitly used in computing the benchmark loss ratios. They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet. They are shown here for informational purposes only.

⁶ To include the earned premium for all years prior to as well as the 15^th year prior to the current year.

APPENDIX B

FORM FOR REPORTING

MEDICARE SUPPLEMENT POLICIES

Company Name: Address:

Address:

Phone Number:

Due March 1, annually

The purpose of this form is to report the following information on each resident of this state who has in force more than one Medicare supplement policy or certificate. The information is to be grouped by individual policyholder.

Policy and

Certificate #

Date of

Issuance

___________________

Signature

___________________

Name and Title (please type)

___________________

Date

APPENDIX C

DISCLOSURE STATEMENTS

Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare

1. Section 1882(d) of the federal Social Security Act [ 42 U.S.C. 1395ss] prohibits the sale of a health insurance policy (the term policy includes certificate) to Medicare beneficiaries that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary's other health coverage and it includes the prescribed disclosure statement on or together with the application for the policy.

2. All types of health insurance policies that duplicate Medicare shall-include one of the attached disclosure statements, according to the particular policy type involved, on the application or together with the application. The disclosure statement may not vary from the attached statements in terms of language or format (type size, type proportional spacing, bold character, line spacing, and usage of boxes around text).

3. State and federal law prohibits insurers from selling a Medicare supplement policy to a person that already has a Medicare supplement policy except as a replacement policy.

4. Property/casualty and life insurance policies are not considered health insurance.

5. Disability income policies are not considered to provide benefits that duplicate Medicare.

6. Long-term care insurance policies that coordinate with Medicare and other health insurance are not considered to provide benefits that duplicate Medicare.

7. The federal law does not preempt state laws that are more stringent than the federal requirements.

8. The federal law does not preempt existing state form filing requirements.

9. Section 1882 of the federal Social Security Act was amended in Subsection (d)(3)(A) to allow for alternative disclosure statements. The disclosure statements already in Appendix C remain. Carriers may use either disclosure statement with the requisite insurance product. However, carriers should use either the original disclosure statements or the alternative disclosure statements and not use both simultaneously.

[Original disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

* hospital or medical expenses up to the maximum stated in the policy

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that provide benefits for specified limited services.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

* any of the services covered by the policy are also covered by Medicare

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses only when you are treated for one of the specific diseases or health conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

* hospital or medical expenses up to the maximum stated in the policy Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS INSURANCE DUPLICATES SOME MEDICARE BENEFIT'S

This is not Medicare Supplement Insurance

This insurance pays a fixed amount, regardless of your expenses, if you meet the policy conditions, for one of the specific diseases or health conditions named in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits because Medicare generally pays for most of the expenses for the diagnosis and treatment of the specific conditions or diagnoses named in the policy.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

* any expenses or services covered by the policy are also covered by Medicare Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

* any expenses or services covered by the policy are also covered by Medicare; or

* it pays the fixed dollar amount stated in the policy and Medicare covers the same event

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice care

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items & services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Original disclosure statement for other health insurance policies not specifically identified in the preceding statements.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance provides limited benefits if you meet the conditions listed in the policy. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

* the benefits stated in the policy and coverage for the same event is provided by Medicare

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that provide benefits for specified limited services.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits under this policy.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments. This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy. Medicare generally pays for most or all of these expenses.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments. This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice care

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items & services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance departMent or state [health] insurance [assistance] program [SHIP].

[Alternative disclosure statement for other health insurance policies not specifically identified in the preceding statements.]

IMPORTANT NOTICE TO PERSONS ON MEDICARE

THIS IS NOT MEDICARE SUPPLEMENT INSURANCE

Some health care services paid for by Medicare may also trigger the payment of benefits from this policy.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

* hospitalization

* physician services

* hospice

* [outpatient prescription drugs if you are enrolled in Medicare Part D]

* other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

Before You Buy This Insurance

[RIGHT] Check the coverage in all health insurance policies you already have.

[RIGHT] For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

[RIGHT] For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

D.C. Mun. Regs. tit. 26, r. 26-A2299

Final Rulemaking published at 46 DCR 10175 (December 17, 1999); as amended by Final Rulemaking published at 50 DCR 4166 (May 30, 2003); as amended by Final Rulemaking published at 50 DCR 5882 (July 25, 2003); as amended by Final Rulemaking published at 53 DCR 2955 (April 14, 2006); as amended by Final Rulemaking published at 56 DCR 8840 (November 13, 2009), incorporating text of Proposed Rulemaking published at 56 DCR 7661, 7724 (September 25, 2009)

Authority: Sections 4, 5, 6, 9, and 11 of the Medicare Supplement Insurance Minimum Standards Act of 1992, effective July 22, 1992 (D.C. Law 9-170; D.C. Official Code §§ 31-3703, 31-3704, 31-3705, 31-3708 and 31-3710 (2001)), and section 4 of Department of Insurance and Securities Regulation Establishment Act of 1996, effective May 21 , 1997 (D.C. Law 11-268; D.C. Official Code § 31-103 (2009 Supp.))