4. a. Do you have another Medicare supplement policy in force?
Yes _____ No _____
b. If so, with what company, and what plan do you have [optional for Direct Mailers]?
______________________________________________
c. If so, do you intend to replace your current Medicare supplement policy with this policy?
Yes ______ No ______
5. Have you had coverage under any other health insurance within the past 63 days? (For example an employer, union, or individual plan)
Yes _____ No ______
a. If so, with what company and what kind of policy?
________________________________________________
________________________________________________
________________________________________________
________________________________________________
b. What are your dates of coverage under the other policy?
START ___/___/___ END ___/___/____
(If you are still covered under the other policy, leave “END” blank.)
Ins 3.39(23)(b)(b) Agents shall list, in a supplementary form signed by the agent and submitted to the issuer with each application for Medicare supplement coverage, any other health insurance policies they have sold to the applicant as follows:
Ins 3.39(23)(b)1.1. Any policy sold which is still in force.
Ins 3.39(23)(b)2.2. Any policy sold in the past 5 years which is no longer in force.
Ins 3.39(23)(bL)(bL) In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant, and acknowledged by the issuer, shall be returned to the applicant by the issuer upon delivery of the policy.
Ins 3.39(23)(c)(c) Upon determining that a sale will involve replacement, an issuer, other than a direct response issuer, or its agent, shall furnish the applicant, prior to issuance or delivery of the Medicare supplement policy or certificate, Medicare select policy or certificate, or Medicare cost policy, a notice regarding the replacement of Medicare supplement coverage in no less than 12 point type. One copy of the notice signed by the applicant and the agent, except where the coverage is sold without an agent, shall be provided to the applicant and an additional signed copy shall be retained by the issuer. A direct response issuer shall deliver to the applicant at the time of the solicitation of the policy the notice regarding replacement of Medicare supplement coverage.
Ins 3.39(23)(d)(d) The notice required by par. (c) for an issuer shall be provided in substantially the form as shown in Appendix 7.
Ins 3.39(23)(e)(e) If the application contains questions regarding health and tobacco usage, include a statement that health questions should not be answered if the applicant is in the open-enrollment period described in sub. (3r), or during a guaranteed issue period under sub. (34).
Ins 3.39(24)(24)Standards for marketing.
Ins 3.39(24)(a)(a) Every issuer marketing Medicare supplement insurance coverage in this state, directly or through its producers, shall do all of the following:
Ins 3.39(24)(a)1.1. Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate.
Ins 3.39(24)(a)2.2. Establish marketing procedures to assure excessive insurance is not sold or issued.
Ins 3.39(24)(a)3.3. Inquire and otherwise make every reasonable effort to identify whether a prospective applicant or insured for Medicare supplement insurance already has accident and sickness insurance and the types and amounts of any such insurance.
Ins 3.39(24)(a)4.4. Display prominently by type-size, stamp or other appropriate means, on the first page of the policy the following: “Notice to buyer: This policy may not cover all of your medical expenses.”