Current through August 31, 2023
01.
Filing of Policy Forms.
(3-31-22)
a. An issuer cannot deliver or issue
for delivery a policy or certificate to a resident of this state unless the
policy form or certificate form has been filed with and approved by the
director in accordance with filing requirements and procedures prescribed by
the director. (3-31-22)
b. An
issuer would file any riders or amendments to policy or certificate forms to
delete outpatient prescription drug benefits as prescribed by the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 only with the
director in the state in which the policy or certificate was issued.
(3-31-22)
02.
Filing of Premium Rates. (3-31-22)
a. An issuer cannot use or change premium
rates for a Medicare supplement policy or certificate unless the rates, rating
schedule, and supporting documentation have been filed with and approved by the
director in accordance with the filing requirements and procedures prescribed
by the director. (3-31-22)
b.
Except as provided in Subsection
051.03, the insured cannot
receive more than one (1) rate increase in any twelve (12) month period.
(3-31-22)
03. Except as
provided in Paragraph 056.03.a., an issuer will not file for approval more than
one (1) form of a policy or certificate of each type for each standard Medicare
supplement benefit plan. (3-31-22)
a. An
issuer may offer, with the approval of the director, up to three (3) additional
policy forms or certificate forms of the same type for the same standard
Medicare supplement benefit plan, one (1) or each of the following cases:
(3-31-22)
i. The inclusion of new or
innovative benefits; (3-31-22)
ii.
The addition of either direct response or agent marketing methods;
(3-31-22)
iii. The addition of
either guaranteed issue or underwritten coverage; (3-31-22)
b. For the purposes of Section
056, "type" means an individual
policy, a group policy, an individual Medicare Select policy, or a group
Medicare Select policy. (3-31-22)
04.
Availability of Policy Form or
Certificate. Except as provided in Paragraph 056.04.a., an issuer
continuously makes available for purchase any policy form or certificate form.
A policy form or certificate form would not be considered available for
purchase unless the issuer has actively offered it for sale continuously during
the previous twelve (12) months. (3-31-22)
a.
An issuer may discontinue the availability of a policy form or certificate form
if the issuer provides to the director in writing its decision at least thirty
(30) days prior to discontinuing the availability of the form of the policy or
certificate. After receipt of this notice by the director, the issuer no longer
offers for sale the policy form or certificate form in this state.
(3-31-22)
b. An issuer that
discontinues the availability of a policy form or certificate form pursuant to
Paragraph 056.04.a. will not file for approval a new policy form or certificate
form of the same type for the same standard Medicare supplement benefit plan as
the discontinued form for a period of five (5) years after the issuer provides
notice to the director of the discontinuance. The period of discontinuance may
be reduced if the director determines that a shorter period is appropriate.
(3-31-22)
c. The sale or other
transfer of Medicare supplement business to another issuer is considered a
discontinuance for the purposes of Subsection
056.04. (3-31-22)
d. A change in the rating structure or
methodology is considered a discontinuance under this Subsection
056.04 unless the issuer
complies with the following requirements: (3-31-22)
i. The issuer provides an actuarial
memorandum, in a form and manner prescribed by the director, describing the
manner in which the revised rating methodology and resultant rates differ from
the existing rating methodology and existing rates. (3-31-22)
ii. The issuer does not subsequently put into
effect a change of rates or rating factors that would cause the percentage
differential between the discontinued and subsequent rates as described in the
actuarial memorandum to change. The director may approve a change to the
differential which is in the public interest.
(3-31-22)
05.
Experience of Policy Forms. (3-31-22)
a. Except as provided in Paragraph 056.05.b.,
the experience of all policy forms or certificate forms of the same type in a
standard Medicare supplement benefit plan is combined for purposes of the
refund or credit calculation prescribed in Section
051. (3-31-22)
b. Forms assumed under an assumption
reinsurance agreement are not combined with the experience of other forms for
purposes of the refund or credit calculation. (3-31-22)
c. The experience of all policy forms or
certificate forms for standardized benefit plans of the same type is combined
for purposes of the rate change filing. Generally, any applicable percentage
increase is filed and applied uniformly across all standardized plans within
the same type, unless doing so would violate the federal lifetime loss ratio
standards for specific forms within the same type.
(3-31-22)
06.
Age
Rating. With respect to Medicare supplement policies that conform to the
Standard Benefit Plans under this chapter: (3-31-22)
a. It is an unfair practice and an unfair
method of competition for any issuer, insurer, or licensee to use the
increasing age of an insured, subscriber or participant as the basis for
increasing premiums or prepayment charges for policyholders who initially
purchase a policy after January 1, 1995. For issue-age rated policies:
(3-31-22)
i. For an individual who is
sixty-five (65) years of age or older, the filed rate for any given age will
not exceed the rate for any higher issue-age, similarly rated individual; and
(3-31-22)
ii. For an individual who
is under sixty-five (65) years of age, the premium is no greater than one
hundred fifty percent (150%) of the premium for an issue-age sixty-five (65)
similarly rated individual, while the individual's attained age is less than
sixty-five (65). Upon attaining age sixty-five (65), a policyholder with an
issue-age less than sixty-five (65) is charged the same premium rate as an
issue-age sixty-five (65), similarly rated individual.
(3-31-22)
b. For policies
issued after February 28, 2022, it is an unfair practice and an unfair method
of competition for any issuer, insurer, or licensee to use the increasing age
or issue age of an insured, subscriber or participant as a basis for premiums.
For such community-rated policies: (3-31-22)
i. For an individual who is eligible for
Medicare Part B only due to disability or end stage renal disease, the premium
is no greater than one hundred fifty percent (150%) of the premium for an
enrollee otherwise eligible for Medicare Part B; and (3-31-22)
ii. Upon attaining Medicare Part B
eligibility due to age, a policyholder who was previously eligible for Medicare
Part B only due to disability or end stage renal disease is to be charged the
same premium rate as an individual eligible for Medicare Part B due to age.
(3-31-22)
07.
Rating by Area and Gender. With respect to Medicare supplement
policies that conform to the Standard Benefit Plans under this chapter, it is
an unfair practice and an unfair method of competition for any issuer, insurer,
or licensee to use area or gender for rating purpose. (3-31-22)
08.
Other Rating Requirements.
With respect to Medicare supplement policies that conform to the Standard
Benefit Plans under this chapter, sold to residents of this State on or after
January 1, 2018: (3-31-22)
a. Any rate
adjustments are uniform between 1990 Standardized and later Standardized plans
throughout the lifetime of the policies, unless doing so would violate the
federal lifetime loss ratio standards for specific forms within the same type.
(3-31-22)
b. The rating by the
issuer does not differentiate on the basis of the reason for eligibility for
Medicare Part B, except for an individual, at any given age, described at
Subparagraph 056.06.b.i. (3-31-22)
09.
Discriminatory Discount or Other
Payment Practices. With respect to Medicare supplement policies that
conform to the Standard Benefit Plans under this chapter: (3-31-22)
a. No discount or underwriting factor of less
than 1.0 will be available to policies issued outside of open enrollment, per
Section 036, or
guaranteed issue, per Section
041, unless the greatest discount
or lowest underwriting factor is automatically applied to all policies issued
under open enrollment and guaranteed issue. (3-31-22)
b. For policies issued after February 28,
2022, it is an unfair practice and an unfair method of competition for any
issuer to require application or policy fees or to vary premium rates based on
payment terms including, without limitation, payment method or frequency of
payment. (3-31-22)
c. Nothing in
this Subsection is construed to limit the ability of an issuer of a Medicare
supplement policy or certificate to apply a discount or underwriting factor
for: (3-31-22)
i. Multiple Medicare
Supplement policies issued to individuals residing within the same household,
or; (3-31-22)
ii. Non-smoking or
non-tobacco use. (3-31-22)