Current through Register 1531, September 27, 2024
(1) A Medicare
Supplement Insurance Policy shall not be advertised, solicited, delivered,
issued, issued for delivery or renewed, unless the Policy meets the following
requirements:
(a) A Medicare Supplement
Insurance Policy shall not indemnify against losses resulting from sickness on
a different basis than losses resulting from accidents.
(b) Any Medicare Supplement Insurance Policy
shall provide that benefits designed to cover cost sharing amounts under
Medicare will be changed automatically to coincide with any changes in the
applicable Medicare deductible amount and copayment percentage factors and any
Medicare Supplement Insurance Policy issued to be effective on or after January
1, 2006 shall provide that benefits will be changed automatically to coincide
with any changes required under Massachusetts law regarding mandated benefits;
premiums may be modified to correspond with such changes, if approved by the
Commissioner in accordance with statutory and regulatory requirements; provided
however, that such Policy shall provide that the Insured agrees to the change
of benefits and premiums based on changes required under Massachusetts law
regarding mandated benefits; provided further that, except as otherwise
required by law, all Medicare Supplement Insurance Policies originally issued
to be effective prior to January 1, 2006 shall maintain any Guaranteed
Renewable fixed drug deductible and the same benefits covered in the original
Policy; and provided further that, except as otherwise required by law, all
Medicare Supplement Insurance Policies originally issued to be effective prior
to January 1, 2020 shall maintain any Guaranteed Renewable benefit to cover the
Medicare Part B deductible and the same benefits covered in the original
Policy.
(c) No Medicare Supplement
Insurance Policy shall contain benefits that duplicate benefits provided by
Medicare.
(d) No Medicare
Supplement Insurance Policy shall contain any waiting period or preexisting
condition limitation or exclusion.
(e) No Medicare Supplement Insurance Policy
shall provide for termination of coverage of a spouse solely because of the
occurrence of an event specified for termination of coverage of the Insured,
other than the nonpayment of premium.
(f) Each Medicare Supplement Insurance Policy
shall be Guaranteed Renewable in accordance with the provisions of
211 CMR
71.07.
(g) No Medicare Supplement Insurance Policy
issued to be effective on or before December 31, 2005, which provides coverage
for prescription drugs, shall exclude coverage of any such drug for the
treatment of cancer or HIV/AIDS on the ground that the off-label use of the
drug has not been approved by the United States Food and Drug Administration
for that indication; provided however, that such drug is recognized for
treatment of such indication in one of the standard reference compendia; or in
the medical literature, as those terms are defined in M.G.L. c. 175, §
47O, or by the Commissioner under the provisions of M.G.L. c. 175, §
47P.
(h) An Issuer of a Medicare
Supplement Insurance Policy shall refund the unearned portion of any premium
paid on a quarterly, semi-annual or annual basis upon the death of a
Policyholder. An Issuer of a Medicare Supplement Insurance Policy may refund
the unearned portion of any premium paid on a quarterly, semi-annual or annual
basis in the case of cancellation by the Policyholder for reasons other than
death. When calculating all such refunds, an Issuer of a Medicare Supplement
Insurance Policy shall convert the billing mode from annual, semi-annual, or
quarterly to monthly as of the date of death or cancellation by the
Policyholder for reasons other than death and refund the premium paid less the
sum of the monthly premiums earned to that point or use a refund methodology
submitted to and approved by the Commissioner. All Medicare Supplement Issuers
shall notify applicants regarding premium refunds in the required outline of
coverage as set forth in
211 CMR
71.13(2)(c)2. Nothing in 211
CMR 71.08(1)(h) shall affect the rights of a Policyholder to return the Policy
within 30 days of its delivery and receive a premium refund pursuant to
211 CMR
71.13(1)(e).
(2) For Medicare Supplement
Insurance Policies issued to be effective on or after January 1, 2006, the
following Medicare Supplement options are mandatory as to standards and
benefits and shall not be modified in any manner, except as provided in
211 CMR
71.09 or
71.21. No other
Medicare Supplement options may be issued to be effective on or after January
1, 2006.
(a)
Medicare Supplement
Core. A Medicare Supplement Core Insurance Policy shall provide
the coverage as specified by the Commissioner and shall not provide any
additional benefits.
(b)
Medicare Supplement 1. A Medicare Supplement 1
Insurance Policy shall provide the coverage specified by the Commissioner and
shall not provide any additional benefits. Notwithstanding the provisions of
any other section, a Medicare Supplement 1 Policy shall not be offered or
issued after December 31, 2019 to persons becoming Medicare Eligible Persons on
or after January 1, 2020. Subject to the provisions of any other section of law
or this regulation, if a company offers persons who became Medicare Eligible
Persons prior to January 1, 2020 the option of enrolling in a Medicare
Supplement 1A plan, they are required to also offer those persons the option of
enrolling in a Medicare Supplement 1 plan. All Medicare Supplement 1 policies
in effect on December 31, 2019 shall be renewed, except as identified in
211 CMR
71.07.
(c)
Medicare Supplement
1A. Beginning January 1, 2020, a Medicare Supplement 1A Insurance
Policy shall provide the coverage specified by the Commissioner and shall not
provide any additional benefits. Subject to the provisions of any other section
of law or
211 CMR 71.00, if an Issuer
offers persons who became Medicare Eligible Persons prior to January 1, 2020
the option of enrolling in a Medicare Supplement 1 plan, they are required to
also offer those persons the option of enrolling in a Medicare Supplement 1A
plan.
(d)
Medicare
Supplement 2. A Medicare Supplement 2 Insurance Policy shall
provide the coverage specified by the Commissioner and shall not provide any
additional benefits. Notwithstanding the provisions of any other section, a
Medicare Supplement Insurance Policy with benefits for outpatient prescription
drugs, including such benefits provided through Alternate Innovative Benefits
Riders shall not be issued after December 31, 2005, but coverage in effect on
December 31, 2005 shall be renewed, except as identified in
211 CMR
71.07(5).
(e)
Medicare Select.
A Medicare Select Insurance Policy shall provide coverage in accordance with
the provisions specified in
211 CMR
71.21.
(3) For Medicare Supplement Insurance
Policies issued to be effective on or after January 1, 2006, an Issuer offering
Medicare Supplement Insurance shall make available to each prospective
Policyholder a Policy form containing only Medicare Supplement Core Insurance
benefits, in accordance with 211 CMR 71.08(2)(a).
(4) No groups, packages or combinations of
Medicare Supplement Insurance benefits other than those listed in 211 CMR
71.08(2) shall be offered for sale to be effective on or after January 1, 2006
in Massachusetts, except as may be permitted in
211 CMR
71.09.
(5) Benefit plans for Medicare Supplement
Insurance Policies issued to be effective on or after January 1, 2006 shall be
uniform in structure, language, designation and format to the standard benefit
plans listed in 211 CMR 71.08(2) and conform to the definitions in
211 CMR 71.03 and
211 CMR
71.05. Each benefit shall be structured in
accordance with the format specified by the Commissioner for a Medicare
Supplement Core Policy, a Medicare Supplement 1 Policy and a Medicare
Supplement 1A Policy, as applicable, and shall list the benefits in the
specified order. For purposes of 211 CMR 71.08, "structure, language, and
format" means style, arrangement and overall content of a benefit.
(6) An Issuer of Medicare Supplement
Insurance may use, in addition to the benefit plan designations required in 211
CMR 71.08(2), other designations or product names to the extent permitted by
law.
(7) Every Issuer shall make
available a Medicare Supplement Core Insurance Policy, as described in 211 CMR
71.08(2)(a), to each prospective Policyholder. An Issuer may make available to
prospective Insureds any of the other Medicare Supplement Insurance benefit
plans for which the prospective Insured is eligible, in addition to the
Medicare Supplement Core.
(8) No
Issuer participating in the market for Medicare Supplement Insurance shall at
any time knowingly permit a newly enrolling Eligible Person to terminate a
Medicare Supplement 1 plan and purchase a Medicare Supplement 1A plan offered
by that Issuer until the person has been covered under the Medicare Supplement
1 plan for at least a period of 12 months.
