Ins 3.39(9)(d)(d) Specified disease coverage. An individual policy form providing benefits only for one or more specified diseases sold to a Medicare eligible person shall bear: Ins 3.39(9)(d)1.1. The designation: SPECIFIED OR RARE DISEASE LIMITED POLICY, and Ins 3.39(9)(d)2.2. The caption: “This policy covers only one or more specified or rare illnesses. It is not a substitute for a broader policy which would generally cover any illness or injury. For more information, see ‘Wisconsin Guide to Health Insurance for People with Medicare’, given to you when you applied for this policy.” Ins 3.39(9)(e)(e) Other coverage. An individual disability policy sold to a Medicare eligible person, other than a form subject to sub. (5) or (7) or otherwise subject to the caption requirements in this subsection or exempted by sub. (2) (d) or (e), shall bear the caption: “This policy is not a Medicare supplement. For more information, see “Wisconsin Guide to Health Insurance for People with Medicare’, given to you when you applied for this policy.” Ins 3.39(10)(a)(a) Conversion requirements. An insured under individual, family, or group hospital or medical coverage who will become eligible for Medicare and is offered a conversion policy which is not subject to subs. (4), (4m), (4t), (5), (5m), (5t) or (7) shall be furnished by the issuer, at the time the conversion application is furnished in the case of individual or family coverage or within 14 days of a request in the case of group coverage. Ins 3.39(10)(b)(b) Continuation requirements. An insured under individual, family, or group hospital or medical coverage who will become eligible for Medicare and whose coverage will continue with changed benefits (e.g., “carve-out” or reduced benefits) shall be furnished by the issuer, within 14 days of a request: Ins 3.39(10)(b)1.1. A comprehensive written explanation of the coverage to be provided after Medicare eligibility, and Ins 3.39(10)(c)(c) Notice to group policyholder. An issuer which provides group hospital or medical coverage shall furnish to each group policyholder: Ins 3.39(10)(c)1.1. Annual written notice of the availability of the materials described in pars. (a) and (b), where applicable, and Ins 3.39(10)(c)2.2. Within 14 days of a request, sufficient copies of the same or a similar notice to be distributed to the group members affected. Ins 3.39(11)(11) “Wisconsin Guide to Health Insurance for People with Medicare” pamphlet. Every prospective Medicare eligible purchaser of any policy or certificate subject to this section which provides hospital or medical coverage, other than incidentally, or of any coverage added to an existing Medicare supplement policy or certificate, except any policy subject to s. Ins 3.46, shall receive a copy of the current edition of the commissioner’s pamphlet “Wisconsin Guide to Health Insurance for People with Medicare” in a type size no smaller than 12 point type at the time the prospect is contacted by an intermediary or issuer with an invitation to apply as defined in s. Ins 3.27 (5) (g). Except in the case of direct response insurance, written acknowledgement of receipt of this pamphlet shall be obtained by the issuer. This pamphlet provides information on Medicare and advice to people on Medicare on the purchase of Medicare supplement insurance and other health insurance. Issuers may obtain information from the commissioner’s office on how to obtain copies or may reproduce this pamphlet themselves. This pamphlet may be periodically revised to reflect changes in Medicare and any other appropriate changes. No issuer shall be responsible for providing applicants the revised pamphlet until 30 days after the issuer has been given notice that the revised pamphlet is available. Ins 3.39(12)(12) Approval not a recommendation. While the commissioner may authorize the use of a particular designation on a policy or certificate in accordance with this section, that authorization is not to be construed or advertised as a recommendation of any particular policy or certificate by the commissioner or the state of Wisconsin. Ins 3.39(13)(13) Exemption of certain policies and certificates from certain statutory Medicare supplement requirements. Policies and certificates described in sub. (2) (d), even if they are Medicare supplement and Medicare select policies as described in s. 600.03 (28r), Stats., or Medicare cost policies as described in s. 600.03 (28p) (a) and (c), Stats., shall not be subject to either of the following: Ins 3.39(13)(b)(b) The special preexisting disease provisions for Medicare supplement, Medicare select, or Medicare cost policies set forth in s. 632.76 (2) (b), Stats. Ins 3.39(14)(14) Other requirements for policies or certificates with effective dates prior to June 1, 2010. Ins 3.39(14)(a)(a) Each issuer issuing policies or certificates to persons first eligible for Medicare prior to June 1, 2010, may file and utilize only one individual Medicare supplement policy form, one individual Medicare select policy form, one individual Medicare cost policy form, one group Medicare select certificate form and one group Medicare supplement certificate form with any of the accompanying riders permitted in sub. (5) (i), unless the commissioner approves the use of additional forms and the issuer agrees to aggregate experience for the various forms in calculating rates and loss ratios. Ins 3.39(14)(b)(b) An issuer shall mail any refund or return of premium directly to the insured and may not require or permit delivery by an agent or other representative. Ins 3.39(14)(c)(c) An issuer shall comply with section 1882 (c) (3) of the social security act, as enacted by section 4081 (b) (2) (C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203, by complying with all of the following: Ins 3.39(14)(c)1.1. Accepting a notice from a Medicare issuer on dually assigned claims submitted by participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of the information contained in that notice. Ins 3.39(14)(c)2.2. Notifying the participating physician or supplier and the beneficiary of the payment determination.