Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.06 - Standards for Medicare Supplement Policies
Section 31.10.06.06 - Open Enrollment

Universal Citation: MD Code Reg 31.10.06.06

Current through Register Vol. 51, No. 19, September 20, 2024

A. Period of Open Enrollment.

(1) An issuer may not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of the policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant when:
(a) An application for the policy or certificate is submitted during the 6-month period beginning with the first day of the first month in which an individual is both 65 years old or older and is enrolled for benefits under Medicare Part B; or

(b) An application for the policy or certificate is submitted on or up to 30 days after the birthday of an individual enrolled in a Medicare supplement policy or certificate.

(2) Each Medicare supplement policy and certificate currently available from an issuer shall be made available to all applicants who qualify under §A(1)(a) of this regulation without regard to age.

(3) Subject to Regulation .31A of this chapter, an insurer shall make available to applicants who qualify under §A(1)(b) of this regulation Medicare supplement policies or certificates with benefits that are equal to or less than the benefits of the applicant's existing Medicare supplement policy or certificate. For the purpose of this regulation, "benefits that are equal to or less than the benefits of the applicant's existing Medicare supplement policy or certificate" means a policy or certificate of the same or lower benefit level as indicated in the below chart:

Existing Plan

Lesser or Equal Plan

Plan A

Plan A

Plan B

Plan A or B

Plan C

Plan A, B, C, D, K, L, M, or N

Plan D

Plan A, B, D, K, L, M, or N

Plan E

Plan A, B, D, K, L, M, or N

Plan F

Plan A, B, C, D, F, F with a high deductible, G, G with a high deductible, K, L, M, or N

Plan F with a high deductible

Plan F with a high deductible or G with a high deductible

Plan G

Plan A, B, D, G, K, L, M, N, F with a high deductible, or G with a high deductible

Plan G with a high deductible

Plan G with a high deductible

Plan H

Plan A, B, D, K, L, M, or N

Plan I

Plan A, B, D, G, K, L, M, or N

Plan J

Plan A, B, C, D, F, F with a high deductible, G, G with a high deductible, K, L, M, or N

Plan J with a high deductible

Plan F with a high deductible or G with a high deductible

Plan K

Plan K

Plan L

Plan K or L

Plan M

Plan M or N

Plan N

Plan N

B. Application of Creditable Coverage.

(1) If an applicant qualifies under §A of this regulation and submits an application during the time period referenced in §A of this regulation and, as of the date of application, has had a continuous period of creditable coverage of at least 6 months, the issuer may not exclude benefits based on a preexisting condition.

(2) If the applicant qualifies under §A of this regulation and submits an application during the time period referenced in §A of this regulation and, as of the date of application, has had a continuous period of creditable coverage that is less than 6 months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date.

(3) The Secretary shall specify the manner of the reduction under §B(2) of this regulation.

C. Except as provided in §B of this regulation and in Regulations .09-1 and .18 of this chapter, §A of this regulation is not to be construed as preventing the exclusion of benefits under a policy during the first 6 months based on a preexisting condition for which the policyholder or certificate holder received treatment or was otherwise diagnosed during the 6 months before the policy became effective.

D. Individuals Younger than 65 Years Old and Enrolled in Medicare Part B. An issuer shall comply with the open enrollment requirements that are described in Insurance Article, § 15-909, Annotated Code of Maryland, as applying to individuals who are both younger than 65 years old and enrolled in Part B of Medicare.

Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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