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1

Medicare supplement insurance:
medicare supplement insurance must

prominently disclose that the policyholder has the right to return the policy or certificate within 30 days of its delivery for a full refund of premium if the insured is not satisfied for any reason.

2

Preexisting conditions:
A medicare Supplement may not

deny coverage for preexisting conditions for more than 6 months after the effective date of coverage.
1 time in lifetime

3

In home sales
A producer selling a medicare supplement in a purchaser's home must

give the purchaser his/her name, address, and telephone number, and the insurer's name
Complete, in the purchaser's presence, a Policy Checklist in duplicate. The Policy checklist must be signed and given to the purchaser and insurer. The insurer must maintain a copy on file at its administrative office.

4

An insurer providing Medicare Supplements must:

Annually file its rates, rating schedule, and other documentation demonstrating that it complies with loss ratio standards of Illinois
Submit a copy of any Medicare Supplement advertisement to the Director for review

5

An advertisement describing Medicare must

State that the insurer and agent are not connected with the Medicare program
Disclose that it is an insurance advertisement
Identify the insurer's actual address
Indicate that a failure to respond will not jeopardize medicare coverage
State if one of the insurer's representatives will deliver any material or information in person

6

A medicare supplement may not:

Limit or exclude coverage more restrictively than Medicare does except for preexisting conditions
Use waivers to exclude, limit, or reduce coverage or benefits for specifically named preexisting diseases or physical conditions.
Duplicate benefits provided by Medicare

7

A medicare supplement insurer may not deny coverage to an applicant

under 65 years of age who meets any of the following criteria:
Becomes eligible for Medicare by reason of disability if the person makes application for a Medicare supplement policy within 6 months of the first day on which the person enrolls for benefits under Medicare Part B.
Has Medicare and an employer group health plan that terminates or ceases to provide all such supplemental health benefits
Is insured by a Medicare Advantage or medicare supplement policy and the insurer goes out of business, withdraws from the market, or the insurer or agents misrepresent the plan and the applicant is without coverage

8

Benefit standards:
A medicare supplement must

Coincide with any changes in the applicable Medicare deductible amount and copayment percentage factors
Be guaranteed renewable: increase premium by a class but must renew

9

A medicare supplement may not

Exclude or limit coverage for preexisting conditions for more than 6 months after the effective date of coverage
Define the term preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage
Indemnify against losses resulting from sickness on a different basis than losses resulting from accidents
Terminate spousal coverages solely because the insured's coverage terminates, except for nonpayment of premium

10

An insurer may not cancel or nonrenew a Medicare Supplement

Solely because of an individuals health status
For any reason other than nonpayment of premium or material misrepresentation

11

Long-Term Care insurance
any health policy or rider advertised, marketed, offered, or designed to provide coverage for at least

12 consecutive months for each covered person

12

Traditional Long-term care
Preexisting condtions
A Long-term care policy may not

deny coverage for preexisting conditions for more than 6 months after the effective date of coverage.

13

Prohibited provisions
An LTC policy may not

Be terminated on the grounds of the insured's age or deterioration in health
Establish a new waiting period when converting or replacing coverage within the same company, except for a benefit increase that the insured voluntarily selects
Cover skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care.

14

prior institutionalization
An LTC policy may not:

Condition eligibility for any benefits on a prior hospitalization requirement
Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care.
Condition eligibility for any benefits other than waiver of premium, post-confinement, post-acute care, or recuperate benefits on prior institutionalization.
Require a prior institutional stay of more than 30 days if conditioning eligibility for noninstitutional benefits on the prior receipt of institutional care
Condition eligibility for benefits upon admission to a facility for the same or related condition within fewer than 30 days after discharge from the institution if providing benefits only following institutionalization.

15

The free-look period on LTC policies is

30 days, subject to a premium refund

16

An outline of coverage must

be delivered to an applicant during the initial solicitation.

17

An LTC policy must be delivered to the

applicant within 30 days after the underwriter date of approval. Claim denial must be accompanied by written reasons for denial.

18

Illinois long-term are partnership program
The Illinois long-term care partnership program is administered by the department of healthcare and family services with the assistance of the department of insurance to do the following

provide incentives for individuals to insure against the costs of providing for their LTC needs
Provide a mechanism for individuals to qualify for coverage of the cost of their LTC needs under medicaid without first being required to exhaust their assets.
Provide counseling services to individuals planning for their LTC needs
Alleviate the financial burden on the State's medical assistance program by encouraging the pursuit of private initiatives
dollar for dollar benefit payout

19

If an individual is a beneficiary of the Partnership certified policy

the total assets an individual owns and may retain under medicaid and still qualify for benefits under Medicaid at the time the individual applies for LTC benefits increased by $1 for each $1 of benefit paid out under the individual's certified policy

20

Advertising: Form and Content
A health policy's ad format and content must

be complete and clear and avoid deception. The Director determines whether an ad has the capacity or tendency to mislead or deceive.

21

No ad may use words or phrases in a manner

that exaggerates any benefits beyond the terms of the policy

22

Testimonials and endorsements must

be genuine, up to date, and authorized by the endorser

23

Advertisement may

not make comparisons that are unfair or disparaging to other organizations.

24

Record Keeping
Each insurer must keep all ads on file in its office for

4 years or until the next Department examination. Also, each insurer must file a certificate of compliance with ad regulations with its annual statement.

25

minimum standards for individual policies:
Prohibited provisions
No individual policy may

establish a waiting period, except for sickness (30 days) or non-emergency hernia, varicose veins, adenoids, appendix and tonsils (6 months).

26

Accident policies may not

contain a probationary or waiting period

27

A policy may be issued as a dividend only if

an equivalent cash payment is offered to the policyholder as an alternative to such dividend policy or rider. No such dividend may be issued for an initial term of less than 6 months.

28

A disability policy, hospital confinement indemnity policy or specified disease policy may contain a cash value benefit only if it

provides return of 100% of all premiums paid, less the claims incurred, by the time the insured attains age 65.

29

Benefit standards
A guaranteed or non-cancelable policy may not

terminate coverage for a spouse except for nonpayment premium

30

Basic hospital expense coverage must provide

at least 80% of the charges for semi-private room accommodations, or $100 per day (may be reduced to $70 outside the metropolitan area).