Pennsylvania Statutes Title 40 P.S. Insurance § 3108. Requirements for replacement

(a) Application or enrollment forms shall include a question designed to elicit information as to whether a certificate to be issued under a medicare supplement policy is intended to replace any other accident and health insurance presently in force. A supplementary application or other form to be signed by the applicant containing such a question may be used.

(b) Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, or its agent, shall furnish the applicant, prior to issuance or delivery of the certificate, a notice designed to inform the applicant of the essential differences in coverage on a form consistent with the then current model notification form adopted by the National Association of Insurance Commissioners. One copy of such notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer. A direct response insurer shall deliver the notice to the applicant upon issuance of the certificate.