GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 1991
CHAPTER 815
AN ACT TO AMEND THE MEDICARE SUPPLEMENT INSURANCE STATUTES AS REQUIRED BY FEDERAL LAW.
The General Assembly of North Carolina enacts:
Section 1. G.S. 58-54-1(5) reads as rewritten:
"(5) 'Policy' means a
Medicare supplement policy, which is a group or individual policy of accident
and health insurance under Articles 1 through 64 of this Chapter, a subscriber
contract under Articles 65 and 66 of this Chapter, or an evidence of coverage
under Article 67 of this Chapter, other than a policy issued pursuant to a
contract under section 1876 or section 1833 of the federal Social Security Act
(42) U.S.C. § 1395 et seq.), or an issued policy under a demonstration
project authorized pursuant to amendments to the federal Social Security Act, 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 by reason of age. Medicare."
Sec. 2. G.S. 58-54-25 reads as rewritten:
"§ 58-54-25. Disclosure standards.
(a) In order to provide for full and fair disclosure in the sale of policies, no policy or certificate shall be delivered in this State unless an outline of coverage is delivered to the applicant at the time application is made.
(b) The Commissioner shall prescribe the format and content of the outline of coverage required by subsection (a) of this section. For purposes of this section, 'format' means style, arrangement, and overall appearance, including such items as the size, color, and prominence of type and arrangement of text and captions. Such outline of coverage shall include:
(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the exceptions, reductions, and limitations contained in the policy;
(3) A statement of the renewal provisions, including any reservation by the insurer of a right to change premiums; and
(4) 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 may
prescribe by rule a standard form and the contents of an informational brochure
for persons eligible for Medicare by reason of age, 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
rule that the information brochure be provided to any prospective insured
eligible for Medicare concurrently with delivery of the outline of
coverage. With respect to direct response insurance policies, the
Commissioner may require by rule that the prescribed brochure be provided
upon request to any prospective insured eligible for Medicare by reason of
age, Medicare, but in no event later than the time of policy
delivery.
(d) The Commissioner may
adopt rules 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 health
insurance policies sold to persons eligible for Medicare by reason of age, Medicare,
other than: Medicare supplement policies; disability income policies;
basic, catastrophic, or major medical expense policies; or single premium,
nonrenewable policies.
(e) The Commissioner may
further adopt rules to govern the full and fair disclosure of the information
in connection with the replacement of accident and health insurance policies,
subscriber contracts, or certificates by persons eligible for Medicare by
reason of age. Medicare."
Sec. 3. G.S. 58-54-10(e) is repealed.
Sec. 4. G.S. 58-54-20(a) reads as rewritten:
"(a) Every insurer
providing group Medicare supplement insurance benefits to a resident of this
State pursuant to G.S. 58-54-5 shall file a copy of the master policy and any
certificate used in this State in accordance with the filing requirements and
procedures applicable to group policies issued in this State:
Provided, however, that no insurer is required to make a filing earlier than 30
days after insurance is provided to a resident of this State under a master
policy issued for delivery outside this State."
Sec. 5. This act is effective upon ratification.
In the General Assembly read three times and ratified this the 1st day of July, 1992.
James C. Gardner
President of the Senate
Daniel Blue, Jr.
Speaker of the House of Representatives