---
kind: "section"
citation: "42 C.F.R. § 403.232"
title: "42"
number: "403.232"
heading: "Requirements and procedures for obtaining certification."
url: "https://uscodex.org/cfr/42/403.232"
---

# §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 [§ 403.210](/cfr/42/403.210.md);
  - (2) The loss ratio standards specified in [§ 403.215](/cfr/42/403.215.md); 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.**
  - (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 [§ 403.250](/cfr/42/403.250.md).
  - (10) Loss ratio supporting data, as specified in [§ 403.256](/cfr/42/403.256.md).
  - (11) A statement of actuarial opinion, as specified in [§ 403.258](/cfr/42/403.258.md).
  - (12) A statement that the insuring organization will notify the policyholders in writing, within the period of time specified in [§ 403.245(c)](/cfr/42/403.245.md?p=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)](#a) of this section; and
    - (ii) The information submitted to CMS for review is accurate and complete and does not misrepresent any material fact.

## Notes

### Source

Source: 47 FR 32400, July 26, 1982, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.