[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR403.232]



[Page 39-40]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 403_SPECIAL PROGRAMS AND PROJECTS--Table of Contents

 

                Subpart B_Medicare Supplemental Policies

 

Sec. 403.232  Requirements and procedures for obtaining certification.



    (a) To be certified by CMS, a policy must meet--

    (1) The NAIC model standards specified in Sec. 403.210;

    (2) The loss ratio standards specified in Sec. 403.215; and

    (3) Any State requirements applicable to a policy--

    (i) Issued in that State; or

    (ii) Marketed in that State.

    (b) An insuring organization requesting certification of a policy 

must submit the following to CMS for review--

    (1) A copy of the policy form (including all the documents that 

would constitute the contract of insurance that is proposed to be 

marketed as a certified policy).

    (2) A copy of the application form including all attachments.

    (3) A copy of the uniform certificate issued under a group policy.



[[Page 40]]



    (4) A copy of the outline of coverage, in the form prescribed by the 

NAIC model standards.

    (5) A copy of the Medicare supplement buyers' guide to be provided 

to all applicants if the buyers' guide is not the CMS/NAIC buyers' 

guide.

    (6) A statement of when and how the outline of coverage and the 

buyers' guide will be delivered and copies of applicable receipt forms.

    (7) A copy of the notice of replacement and statement as to when and 

how that notice will be delivered.

    (8) A list of States in which the policy is authorized for sale. If 

the policy was approved under a deemer provision in any State, the 

conditions involved must be specified.

    (9) A copy of the loss ratio calculations, as specified in Sec. 

403.250.

    (10) Loss ratio supporting data, as specified in Sec. 403.256.

    (11) A statement of actuarial opinion, as specified in Sec. 

403.258.

    (12) A statement that the insuring organization will notify the 

policyholders in writing, within the period of time specified in Sec. 

403.245(c), if the policy is identified as a certified policy at the 

time of sale and later loses certification.

    (13) A signed statement in which the president of the insuring 

organization, or a designee, attests that--

    (i) The policy meets the requirements specified in paragraph (a) of 

this section; and

    (ii) The information submitted to CMS for review is accurate and 

complete and does not misrepresent any material fact.