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Yes. Additional supplemental benefits for ‘Wellness and/or Well-Baby Care’ can be provided under Accident-Only, Disability Income and Hospital Indemnity insurance when they are “fully disclosed and properly labeled” on the first page of the policy to inform the consumer about the benefits.
The Division also wants to remind carriers of the Colorado statutory requirement that rates must not be excessive and benefits must be reasonable in relation to the premium charged. This is important to remember as implementation of the Affordable Care Act (ACA) moves forward and provides enhanced benefits to consumers. For example, under ACA many preventive services are covered on first-dollar basis under comprehensive, major medical insurance. If a carrier offers Wellness or Well-Baby Care benefits as an additional supplemental benefit under an Accident-Only policy, and the benefit is secondary when coordinated with the major medical coverage, there would be little or no benefit to the consumer, which would result in excessive rates, which conflicts with Colorado law and may conflict with federal laws.
Limited Benefit policies for Accident-Only, Disability Income, and Hospital Indemnity must comply with both Colorado law as well as federal law. For example, a Hospital Indemnity policy with a Well-Baby Expense benefit that has a Coordination of Benefits provision would not meet the requirements as an “Exclusion as an Excepted Benefit” under ACA. Colorado does not allow mini-med plans.
Further, it is important that marketing and advertising not be misleading. For example, a policy should not be advertised as providing coverage for “Accident and Wellness” or “Accident with Well-Baby Care” when the coverage is limited to a single payable benefit or paying for only one benefit during the life of the policy.
The Division is concerned that consumers are purchasing coverage and are not aware of all of the benefits that are included in the policy. Carriers should conspicuously disclose the additional benefits on the first page of the policy form itself. In addition, the policy should be labeled to remind the consumer of the additional benefits (e.g., Accident-Only with Wellness Benefits, Hospital Indemnity with Well-Baby Care Indemnity). This label must appear and be used on the policy form, on the Form Schedule tab in SERFF, and in the rate filing for the policy form or rider.
Carriers are also encouraged to provide additional disclosures to educate consumers, such as including: (a) an acknowledgment on the application form by the applicant of the additional benefits, (b) an identification of the additional benefits in the outline or evidence of coverage (if applicable), and (c) a clear statement of the additional benefits in the advertising or marketing brochure.
If there are specific elements of the actuarial memorandum requirements outlined under Section 6 (e.g., pharmacy claim data for certain Medigap policies), the carrier should include a “not applicable” designation with a brief explanation for that particular section/data element in the filings for those specific policies.
Consolidate LTC requirements into the LTC specific rule? Same for Medigap?
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