Medicare Supplement Policies

What this document is

California Insurance Code Div. 2, Pt. 2, Ch. 1, Art. 6 - Medicare Supplement Policies (Secs. 10192.1 through 10192.24) is a state statute published by California Legislative Counsel (leginfo.legislature.ca.gov). It is one of the California documents that insurance license exam questions are written from, including california life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• Cal. Ins. Code § 10192.5(a)(1) (Standards for policy definitions: accident)

  ““Accident,” “accidental injury,” or “accidental means” shall be defined to employ “result” language and shall not include words that establish an accidental means test or use words such as “external, violent, visible wounds” or other similar words of description or characterization.”

• Cal. Ins. Code § 10192.19(h) (Advertising Standards: Government Connection Disclaimer)

  “(h) No advertisement shall be used that fails to prominently display the disclaimer to the effect of “Not Connected with or endorsed by the U.S. Government or the federal Medicare program.””

• Cal. Ins. Code § 10192.11(h)(1) (Annual birthday open enrollment period)

  “An individual shall be entitled to an annual open enrollment period lasting 60 days or more, commencing with the individual’s birthday, during which time that person may purchase any Medicare supplement policy that offers benefits equal to or lesser than those provided by the previous coverage.”

• Cal. Ins. Code § 10192.20(b)(3) (Prohibited Practices: Cold Lead Advertising)

  “Cold lead advertising, which means making use directly or indirectly of any method of marketing that fails to disclose in a conspicuous manner that a purpose of the method of marketing is the solicitation of insurance and that contact will be made by an insurance agent or insurance company.”

• Cal. Ins. Code § 10192.11(d) (Open enrollment for individuals enrolled in Medicare by disability)

  “An individual enrolled in Medicare by reason of disability shall be entitled to open enrollment described in this section for six months after the date of their enrollment in Medicare Part B, or if notified retroactively of their eligibility for Medicare, for six months following notice of eligibility.”

• Cal. Ins. Code § 10192.3(b) (Medicare supplement article: employer and labor organization exclusion)

  “This article shall not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees, or a combination thereof, or for members or...”

• Cal. Ins. Code § 10192.17(e)(1) (Medicare supplement free look notice and effect of return)

  “Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate, and of the outline of coverage, or attached thereto, in no less than 10-point uppercase type, stating in substance that the policyholder or certificate holder shall...”

• Cal. Ins. Code § 10192.12(a)(1) (Guaranteed issue eligible persons)

  “With respect to the guaranteed issue of a Medicare supplement policy, eligible persons are those individuals described in subdivision (b) who seek to enroll under the policy during the period specified in subdivision (c), and who submit evidence of the date of termination or disenrollment or...”

• Cal. Ins. Code § 10192.17(e)(3) (interest on an untimely free look refund)

  “If the issuer fails to refund all prepaid or periodic charges paid in a timely manner, then the applicant shall receive interest on the paid charges at the legal rate of interest on judgments as provided in Section 685.010 of the Code of Civil Procedure. The interest shall be paid from the date the...”

• Cal. Ins. Code § 10192.14(a)(1)(A) (Medicare supplement loss ratio standards)

  “With respect to loss ratio standards, a Medicare supplement policy form or certificate form shall not be advertised, solicited, or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to...”

• Cal. Ins. Code § 10192.14(a)(3) (mail and mass media solicitations deemed individual policies)

  “For purposes of applying paragraph (1) of subdivision (a) and paragraph (3) of subdivision (d) of Section 10192.15 only, policies issued as a result of solicitations of individuals through the mail or by mass media advertising, including both print and broadcast advertising, shall be deemed to be individual policies.”

• Cal. Ins. Code § 10192.18(d) (notice regarding replacement of Medicare supplement coverage)

  “Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer, or its agent, shall furnish the applicant, prior to issuance for delivery of the Medicare supplement policy or certificate, a notice regarding replacement of...”

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