(a) No insurance
policy or subscriber contract which provides benefits to any resident of this
State who is eligible for Medicare may be advertised, solicited or issued for
delivery in this State if such policy or subscriber contract limits or excludes
coverage by type of illness, accident, treatment or medical condition, except
as follows:
(1) foot care in connection with
corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or
symptomatic complaints of the feet;
(2) mental or emotional disorders, alcoholism
and drug addiction;
(3) illness,
treatment or medical condition arising out of:
(A) war or act of war (whether declared or
undeclared); participation in a felony, riot or insurrection; service in the
armed forces or units auxiliary thereto;
(B) suicide (sane or insane), attempted
suicide or intentionally self-inflicted injury;
(C) aviation;
(4) cosmetic surgery, except that "cosmetic
surgery" shall not include reconstructive surgery when such service is
incidental to or follows surgery resulting from trauma, infection or other
diseases of the involved part;
(5)
Care in connection with the detection and correction by manual or mechanical
means of structural imbalance, distortion, or subluxation in the human body for
purposes of removing nerve interference and the effect thereof, where such
interference is the result of or related to distortion, misalignment or
subluxation of or in the vertebral column;
(6) treatment provided in a governmental
hospital; benefits provided under Medicare or other governmental program
(except Medicaid), any state or federal workers' compensation, employer's
liability or occupational disease law, or any motor vehicle no-fault law;
services rendered by employees of hospitals, laboratories or other
institutions; services performed by a member of the covered person's immediate
family and services for which no charge is normally made in the absence of
insurance;
(7) dental care or
treatment;
(8) eye glasses, hearing
aids and examination for the prescription or fitting thereof;
(9) rest cures, custodial care,
transportation and routine physical examinations;
(10) territorial limitations outside the
United States; provided, however, supplemental policies may not contain, when
issued, limitations or exclusions of the type enumerated in Subsections (1),
(5), (9), or (10) above that are more restrictive than those of Medicare.
Medicare supplement policies may exclude coverage for any expense to the extent
of any benefit available to the insured under Medicare.
(b) No Medicare supplement policy may use
waivers to exclude, limit or reduce coverage or benefits for specifically named
or described preexisting diseases or physical conditions.
(c) The terms "Medicare Supplement,"
"Medigap" and words of similar import shall not be used unless the policy is
issued in compliance with this regulation.
(d) No Medicare supplement insurance policy,
contract or certificate in force in the State shall contain benefits which
duplicate benefits provided by Medicare.
