3 Alaska Admin. Code § 28.502

Current through September 25, 2024

Section 3 AAC 28.502 - Notice regarding policies or certificates that are not medicare supplement policies

(a) A health insurance policy or certificate, other than a medicare supplement policy; a policy issued under a contract under 42 U.S.C. 1395- 1395 ccc (sec. 1876 of the Social Security Act); or a disability income policy or certificate delivered or issued for delivery in this state to a person eligible for medicare must notify insureds under the policy or certificate that the policy or certificate is not a medicare supplement policy. The notice must either be printed on or attached to the first page of the outline of coverage delivered to the insured under the policy or certificate, or, if no outline of coverage is delivered, to the first page of the policy or certificate delivered to the insured. The notice must be in no less than 12-point type and must contain the following language:

"THIS (POLICY OR CERTIFICATE) IS NOT A MEDICARE SUPPLEMENT POLICY. If you are eligible for medicare, review the guide to health insurance for people with medicare available from the company."

(b) An application for a health insurance policy or certificate described in (a) of this section that is provided to a person eligible for medicare must disclose, using the applicable disclosure statement contained in Appendix A of this section, the extent to which the policy duplicates medicare benefits. The disclosure statement must be provided as a part of, or together with, the application for the policy or certificate.

Appendix A DISCLOSURE STATEMENTS

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

1.42 U.S.C. 1395ss(d) (sec. 1882(d) of the Social Security Act) prohibits the sale of a health insurance policy (the term "policy" or "policies" includes "certificates") that duplicates medicare benefits unless the policy will pay benefits without regard to other health coverage and includes the prescribed disclosure statement on or together with the application.

2. All types of health insurance policies that duplicate medicare must 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. Federal law does not preempt state laws that are more stringent than the federal requirements.

8. Federal law does not preempt existing state form filing requirements.

9.42 U.S.C. 1395ss (sec. 1882 of the Social Security Act) was amended in subsection (d)(3)(A) to allow for alternative disclosure statements. The disclosure statements already in this appendix remain. A carrier may use either disclosure statement with the requisite insurance product. A carrier shall use either the original disclosure statements or the alternative disclosure statements, but may 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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 Benefits

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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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 the 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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

- 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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR /bcm For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR 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.

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.

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

UNHANDLEDCHAR Check the coverage in all health insurance policies you already have.

UNHANDLEDCHAR For more information about medicare and medicare supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.

UNHANDLEDCHAR For help in understanding your health insurance, contact your state insurance department or state health insurance assistance program (SHIP).

3 AAC 28.502

Eff. 8/8/90, Register 115; am 7/1/92, Register 122; am 6/4/93, Register 126; am 7/12/96, Register 139; am 4/20/97, Register 142; am 4/21/99, Register 150; am 9/4/2005, Register 175

In 2010 the revisor of statutes, acting under AS 01.05.031, renumbered former AS 21.89.060 as AS 21.96.060. As of Register 196 (January 2011), the regulations attorney made a conforming technical revision under AS 44.62.125(b)(6), to the authority citation that follows 3 AAC 28.502, so that the citation to former AS 21.89.060 now refers to the renumbered statute, AS 21.96.060.

Authority:AS 21.06.090

AS 21.42.130

AS 21.96.060