HEARING - U.S. Senate Special Committee on Aging

HEARING - U.S. Senate Special Committee on Aging HEARING - U.S. Senate Special Committee on Aging

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55 -7- regulators accelerated aient enforcement proceOures to curtail sales acuses. In 1979 HIA'As president wrote all eeier capenies end insurarce regulators cflno for Joint efforts to remedy sales abses by a few, but nevertheless emarrassing n-mber of agents. That sane year, the National Association of hsurance Omissioners appointed a special cols.mer-oriented Advisory Cmmittee on this isste, which 2 clued representatives from M, the FTC, cormsmer and senior citizen groups, and meibers of the insurance industry. As a result of the Advisory Cinittee's efforts, the NAIC then adopteo medel state standards later entraced on the federal level in the 1980 Baucus Amendment. Consequently, virtually all Medicare Supplement policies now on the market meet or exceed those standards. Additionally, this multi-interested Akvisory Cam:ittee developed the Guide to Fealth Insurance for People with Medicare, presently available through HCFA. Current state law reguires that this smplified buyers' guide be provided to purchasers of Medicare Supplement coverage, along with an outline of coverage depicting gaps in Medicare coverage and how particular Medicare Supplement policy benefits relate to these gaps. Also, current law reguires delivery of a special notice when replacement or addition to existing coverage is involved. The HIAA wuld be glad to furnish the toimittee with examples of these materials upon req#est. Further, state law reqirements dealing with Medicare Supplement policies offer the beneficiary the opportunity to return a policy within 30 days of purchase, as well as receive a full refund. Also, state laws dealing with Medicare Supplesent policies reqgre high loss ratios, truth in advertising, fair trade practices (incluclng sales, unaerwriting and clams practices, and simplified policy language requirements), and other valuable consumer protections.

56 To ensure that all of these controls are adequate, an NAIC subcsmmittee recently surveyed state insurance departments regarding citizens' complaints related to Meadigap insurance. This survey indicated that the limited number of camplaints were not the result of any deficiency in NA1C model laws. This same type of process outlined tor Medicare Supplement in protecting the aged is being unoertaken by the insurance industry and the NAIC regarding private long term care insurance. Qarrent efforts center upon developing regulations that will appropriately control the marketplace, yet facilitate experimentation and exploration of what consurers want to purchase in the long term care field. WHAT MEDIGAP POLICIE5 COVER Private Medicare Supplemental policies typically cover such out-of-pocket costs under Medicare as co-payments and deductibles for hespital and doctor services. In keeping with the Baucus Andeent to the 1980 Social Security Disability Act (P.L. 96-265), the states now recpre Medicare Supplement policies to meet certain minimum standards, as follows: - Coverage of Part A coinsurance for Medicare eligible expenses for hospi- talization from the 61st day through the 9Cth day in any Medicare benefit period; - Cverage of Part A coinsurance for Medicare eligible expenses incurred during use of Medicare's lifetime hospital inpatient reserve days;

55<br />

-7-<br />

regulators accelerated aient enforcement proceOures to curtail sales acuses.<br />

In 1979 HIA'As president wrote all eeier capenies end insurarce regulators<br />

cflno for Joint efforts to remedy sales abses by a few, but nevertheless<br />

emarrassing n-mber of agents. That sane year, the Nati<strong>on</strong>al Associati<strong>on</strong> of<br />

hsurance Omissi<strong>on</strong>ers appointed a special cols.mer-oriented Advisory<br />

Cmmittee <strong>on</strong> this isste, which 2 clued representatives from M, the FTC,<br />

cormsmer and senior citizen groups, and meibers of the insurance industry. As<br />

a result of the Advisory Cinittee's efforts, the NAIC then adopteo medel<br />

state standards later entraced <strong>on</strong> the federal level in the 1980 Baucus<br />

Amendment. C<strong>on</strong>sequently, virtually all Medicare Supplement policies now <strong>on</strong><br />

the market meet or exceed those standards.<br />

Additi<strong>on</strong>ally, this multi-interested Akvisory Cam:ittee developed the Guide<br />

to Fealth Insurance for People with Medicare, presently available through<br />

HCFA. Current state law reguires that this smplified buyers' guide be<br />

provided to purchasers of Medicare Supplement coverage, al<strong>on</strong>g with an outline<br />

of coverage depicting gaps in Medicare coverage and how particular Medicare<br />

Supplement policy benefits relate to these gaps. Also, current law reguires<br />

delivery of a special notice when replacement or additi<strong>on</strong> to existing coverage<br />

is involved. The HIAA wuld be glad to furnish the toimittee with examples of<br />

these materials up<strong>on</strong> req#est.<br />

Further, state law reqirements dealing with Medicare Supplement policies<br />

offer the beneficiary the opportunity to return a policy within 30 days of<br />

purchase, as well as receive a full refund. Also, state laws dealing with<br />

Medicare Supplesent policies reqgre high loss ratios, truth in advertising,<br />

fair trade practices (incluclng sales, unaerwriting and clams practices, and<br />

simplified policy language requirements), and other valuable c<strong>on</strong>sumer<br />

protecti<strong>on</strong>s.

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