§403.232. Requirements and procedures for obtaining certification.
42 C.F.R. § 403.232
To be certified by CMS, a policy must meet—
The NAIC model standards specified in § 403.210;
The loss ratio standards specified in § 403.215; and
Any State requirements applicable to a policy—
Issued in that State; or
Marketed in that State.
An insuring organization requesting certification of a policy must submit the following to CMS for review—
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).
A copy of the application form including all attachments.
A copy of the uniform certificate issued under a group policy.
A copy of the outline of coverage, in the form prescribed by the NAIC model standards.
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.
A statement of when and how the outline of coverage and the buyers' guide will be delivered and copies of applicable receipt forms.
A copy of the notice of replacement and statement as to when and how that notice will be delivered.
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.
A copy of the loss ratio calculations, as specified in § 403.250.
Loss ratio supporting data, as specified in § 403.256.
A statement of actuarial opinion, as specified in § 403.258.
A statement that the insuring organization will notify the policyholders in writing, within the period of time specified in § 403.245(c), if the policy is identified as a certified policy at the time of sale and later loses certification.
A signed statement in which the president of the insuring organization, or a designee, attests that—
The policy meets the requirements specified in paragraph (a) of this section; and
The information submitted to CMS for review is accurate and complete and does not misrepresent any material fact.
Notes, amendments, and revision history
Source
Source: 47 FR 32400, July 26, 1982, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302 and 1395hh.