Section 42.09 - Requirements for Disclosure(1)General Rules.(a) No misleading policy names may be used and no policy may be marketed or advertised as a group policy unless it qualifies as such. A carrier's policy name may not misrepresent the extent of benefits actually provided nor may a name be used which conflicts with the prescribed category name or which is similar to the prescribed name of a different category.(b) If age is to be used as a determining factor for reducing the benefits made available in the policy as originally issued, such fact must be prominently set forth in the policy.(c) All insurance policies must contain a renewability provision on the first page of the policy in highlighted section.(d) In the event that the policy is issued on a basis other than that applied for, a disclosure statement properly describing the policy must accompany the policy when it is delivered and contain the following statement, in no less than 12-point type, immediately above the company name: "NOTICE: Read this disclosure statement carefully. The coverage you originally applied for has not been issued. This policy is therefore not identical to the coverage you requested - it differs in the following respects: [ list ]."(e) Any Non-Medicare-Supplement policy summary delivered to a person eligible for Medicare must conspicuously display on its first page the following statement unless the policy does not cover hospital, medical or surgical expenses: "This policy IS NOT A MEDICARE SUPPLEMENT POLICY." The statement may be printed or affixed by sticker.(f) Policies providing conversion privileges must specify the benefits to be provided or must state that the converted coverage shall be on the policy form then being issued by the company for this purpose.(2)Requirements for Policy Applications. Any rider or endorsement forms used to reduce or eliminate coverage at date of policy issue shall be ineffective without signed acceptance by the policyholder. Riders or endorsements that provide a benefit for which a specific premium is charged must show the premium on the application, rider, or elsewhere in the policy. When the Medical Information Bureau is used by the carrier, the policy application or another appropriate notice must indicate the possible use of this service as it relates to medical information concerning the insured.(3)Required Disclosure Forms. (a) No individual accident and sickness insurance policy or contract may be delivered or issued for delivery in Massachusetts unless the disclosure form is delivered with the policy, or is delivered to the applicant at the time application is made. This summary must be a part of the policy and must be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten point with a lower-case unspaced alphabet length not less than 120-point.(b) If the policy is issued on a changed basis, a revised summary must be affixed to the policy.(c) Except as otherwise provided, disclosure forms must provide the following information when applicable: 1. The name of carrier, the description of the policy type, and the policy number.2. A description of the benefits in a manner that does not misrepresent the actual coverage provided.3. Any deductibles, coinsurance, and benefit maximums.4. Whether the policy is renewable to eligibility for Medicare.5. Whether there are age limitations.6. Whether the policy is subject to increase in premiums.7. Any pre-existing condition limitations.9. Whether mental illness is covered and the extent of benefits.10. Whether pregnancy is covered.11. Free look provisions and the procedure for returning the policy for a refund.12. The following statement or similar language as approved by the Commissioner: "Read your policy carefully. This disclosure statement is a very brief summary of your policy. The policy itself sets forth the rights and obligations of both you and the insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY."13. Exclusions, limitations, and reductions listed in a manner that does not misrepresent the actual coverage provided.14. The following statement or similar language as approved by the Commissioner: "COMPLAINTS: If you have a complaint, call your agent. If you are not satisfied, you may write or call the Massachusetts Division of Insurance."(d) Policy summaries and disclosure forms for long-term care insurance must comply with the provisions of 211 CMR 65.00.(4)Required Disclosure for Medicare-Eligible Policyholders and Certificate holders. (a)Guide to Health Insurance for People with Medicare. 1. Carriers of accident and sickness policies or certificates which provide hospital or medical expense coverage on an expense incurred or indemnity basis to a person(s) eligible for Medicare must provide to those applicants a Guide to Health Insurance for People with Medicare in the form developed jointly by the National Association of Insurance Commissioners and the Health Care Financing Administration and in a type size no smaller than 12 point type. The Guide shall also include an attachment concerning the Massachusetts Medicare Supplement Insurance Program in a form prescribed by the Commissioner in a type size no smaller than 12 point type. Delivery of the Guide shall be made whether or not such policies or certificates are advertised, solicited or issued as Medicare Supplement policies or certificates as defined in 211 CMR 71.00. Except in the case of direct response carriers, delivery of the Guide shall be made to the applicant at the time of application and acknowledgment of receipt of the Guide shall be obtained by the carrier. Direct response carriers shall deliver the Guide to the applicant upon request but not later than at the time the Policy is delivered.2. For the purposes of 211 CMR 42.09(4)(a)1., "form" means the language, format, type size, type proportional spacing, bold character and line spacing.(b)Required Notice for Non-medicare Supplement Policies. 1. Any accident and sickness insurance or long-term care insurance policy or certificate, other than a Medicare Supplement policy, a policy issued pursuant to a contract under Section 1876 of the federal Social Security Act ( 42 U.S.C. § 1395, et seq.); disability income policy or other policy identified in 211 CMR 71.02(2), issued for delivery in Massachusetts to persons eligible for Medicare shall notify insureds under the policy that the policy is not a Medicare Supplement policy or certificate. The notice shall either be printed or attached to the first page of the outline of coverage delivered to insureds under the policy, or if no outline of coverage is delivered, to the first page of the policy, or certificate delivered to insureds. The notice shall be in no less than 12 point type and shall contain the following language: "THIS [POLICY OR CERTIFICATE] IS NOT A MEDICARE SUPPLEMENT [POLICY OR CONTRACT]. If you are eligible for Medicare, review the Guide to Health Insurance for People with Medicare available from the company."
2. Applications provided to persons eligible for Medicare for the health insurance or long-term care insurance policies or certificates described in 211 CMR 71.13(2)(d)5.a shall disclose, using the applicable statement in 211 CMR 71.100: Appendix H, the extent to which the policy duplicates Medicare. The disclosure statement shall be provided as a part of, or together with, the application for the policy or certificate.