Current through Register 1531, September 27, 2024
(1) No Issuer
participating in the market for Medicare Supplement Insurance shall at any time
deny or condition the issuance of any Medicare Supplement Insurance Policy or
Alternate Innovative Benefit Rider for sale in Massachusetts, nor discriminate
in the pricing of such a plan, to any Eligible Person because of the age,
health status, claims experience, receipt of health care, medical condition, or
genetic information of the Eligible Person. No Issuer participating in the
market for Medicare Supplement Insurance shall require genetic tests or private
genetic information as a condition of the issuance or renewal of a Medicare
Supplement Insurance Policy or Alternate Innovative Benefit Rider.
(2) No Medicare Supplement Insurance Policy
or Alternate Innovative Benefit Rider may contain any waiting period or
preexisting condition limitation or exclusion.
(3)
Required Part B Open
Enrollment Period. An Issuer of Medicare Supplement Insurance
shall not deny or condition the issuance or effectiveness of any Medicare
Supplement Insurance Policy available for sale in Massachusetts, nor any
Alternate Innovative Benefit Rider, nor discriminate in the pricing of such a
Policy because of the health status, claims experience, receipt of health care,
or medical condition of an Applicant in the case of an application for a Policy
for which the Applicant is eligible that is submitted prior to or during the
six-month period beginning with the first day of the first month in which an
individual is both 65 years of age or older and is enrolled for benefits under
Medicare Part B. Each Medicare Supplement Insurance Policy or Alternate
Innovative Benefit Rider currently available from an Issuer shall be made
available to all Eligible Persons who apply and who qualify under 211 CMR
71.10(3), except as provided in 211 CMR 71.10(11). Notwithstanding 211 CMR
71.10(3), a Medicare Supplement 1 Insurance Policy may only be offered to
Medicare Eligible persons if the individual has also:
(a) attained 65 years of age before January
1, 2020; or
(b) first become
eligible for Medicare due to age, disability, or end-stage renal disease before
January 1, 2020.
(4)
Required Open Enrollment Period for Those Initially Eligible for
Coverage. An Issuer participating in the market for Medicare
Supplement Insurance shall not deny or condition the issuance or effectiveness
of any Medicare Supplement Insurance Policy or Alternate Innovative Benefit
Rider, nor discriminate in the pricing of such Policy or Alternate Innovative
Benefit Rider to an Eligible Person in the case of an application of such
Policy or Alternate Innovative Benefit Rider that is submitted prior to or
during the six-month period beginning with the first day of the first month in
which the Eligible Person became Initially Eligible for Coverage. Each Medicare
Supplement Insurance Policy or Alternate Innovative Benefit Rider currently
available from the Issuer shall be made available to all Eligible Persons who
qualify under 211 CMR 71.10(4), except as provided in 211 CMR 71.10(10).
Notwithstanding the above, a Medicare Supplement 1 Insurance Policy may not be
offered to Medicare Eligible persons if the individual has not also:
(a) attained 65 years of age before January
1, 2020; or
(b) first become
eligible for Medicare due to age, disability or end-stage renal disease before
January 1, 2020.
(5)
Required Annual Open Enrollment Period.
(a) Every Issuer participating in the market
for Medicare Supplement Insurance shall make available during the required
annual open enrollment period to every Eligible Person each Medicare Supplement
Insurance Policy or Alternate Innovative Benefit Rider, currently available
from the Issuer for whom an application for such Policy is submitted during the
required annual open enrollment period by the Eligible Person except as
provided in 211 CMR 71.10(10). The required annual open enrollment period for
Eligible Persons shall commence on February 1st and
end on March 31st of each year, for coverage to be
effective June 1st of that year or no later than
when Medicare coverage is first effective, whichever is earlier.
(b) For annual open enrollment periods, every
Issuer participating in the market for Medicare Supplement Insurance shall
provide its Insureds or Members with written notice no later than January
1st of each such calendar year which provides, at
least, the following information in easy to understand language:
1. an explanation of the existence of the
annual open enrollment period which will be held during February and March of
that year, the deadline of March 31st for
applications, and effective date for new coverage of June
1st of that year;
2. notification that persons who became
Medicare Eligible prior to January 1, 2020 and who enroll in Medicare
Supplement 1 plans on and after January 1, 2020 will only be permitted to
switch enrollment to a Medicare Supplement 1A plan in the same company after
those persons have been covered by the Medicare Supplement 1 plan for at least
a 12-month period, except in the situation where the Commissioner notifies
Issuers that there will be a Required Open Enrollment Period during the course
of the plan year; and
3.
notification that the Insured or Member may request a list of all Issuers which
have available Medicare Supplement Insurance Policy forms as of January
1st of that calendar year by contacting the
Massachusetts Division of Insurance at 1000 Washington St., Suite 810, Boston,
MA 02118-6200, telephone number 1-877-563-4467; or the Executive Office of
Elder Affairs, One Ashburton Place, Room 517, Boston, MA 02108, telephone
number 1-800-243-4636;
(6)
Required Open Enrollment
Period Due to Termination of HMO Medicare Part C Contract. In the
event that a Health Maintenance Organization's Medicare Part C Contract with
Medicare has been terminated, during an open enrollment period scheduled and
authorized by the Commissioner, every Issuer participating in the market for
Medicare Supplement Insurance and every Health Maintenance Organization
participating in the market for Evidences of Coverage Issued Pursuant to a
Medicare Part C Contract with Medicare shall make available to every Eligible
Person each Medicare Supplement Insurance Policy, Alternate Innovative Benefit
Rider or Evidence of Coverage currently available from the Issuer or Health
Maintenance Organization if the Eligible Person's Evidence of Coverage Issued
Pursuant to a Medicare Part C Contract with Medicare was canceled or not
renewed because the Health Maintenance Organization's Medicare Part C Contract
with Medicare has been terminated, except as provided in 211 CMR 71.10(10).
Such coverage shall comply with all the provisions of
211 CMR 71.00 and shall
become effective on the date that coverage under the Medicare Part C Contract
with Medicare ends. The Commissioner will notify all Issuers and Health
Maintenance Organizations subject to 211 CMR 71.10(6) of the time period for
the open enrollment period described in 211 CMR 71.10(6) as soon as
practicable. The length of the open enrollment period under 211 CMR 71.10(6)
shall be set by the Commissioner as he or she deems to be warranted to ensure
that all Applicants have a reasonable opportunity to obtain coverage.
(7)
Required Open Enrollment
Period Established under Administrative Supervision of an Issuer.
In the event that the Commissioner assumes administrative supervision of an
Issuer in accordance with M.G.L. c. 175J, and he or she orders the Issuer to
reduce, suspend or limit the volume of business being accepted or renewed,
including Medicare Supplement Insurance or Alternate Innovative Benefit Riders,
during an open enrollment period scheduled and authorized by the Commissioner,
every Issuer participating in the market for Medicare Supplement Insurance and
Alternate Innovative Benefit Rider shall make available to every Eligible
Person each Medicare Supplement Insurance Policy and Alternate Innovative
Benefit Rider for which the Eligible Person is eligible that is currently
available from the Issuer if the Eligible Person's Policy or Alternate
Innovative Benefit Rider was canceled or not renewed in compliance with the
Commissioner's order in accordance with 211 CMR 71.10(7), except as provided in
211 CMR 71.10(10). Such coverage shall comply with all the provisions of
211 CMR 71.00 and shall
become effective on the date that coverage under the Medicare Part C Contract
with Medicare Policy or Rider ends. The Commissioner will notify all Issuers
subject to 211 CMR 71.10(7) of the time period for the open enrollment period
described in 211 CMR 71.10(7) as soon as practicable. The length of the open
enrollment period under 211 CMR 71.10(7) shall be set by the Commissioner as he
or she deems to be warranted to ensure that all Applicants have a reasonable
opportunity to obtain coverage.
In the event of the placing of an Issuer in administrative
supervision, conservation, rehabilitation, reorganization, liquidation or any
other similar proceeding by a governmental or public authority, the
Commissioner may also establish a Required Open Enrollment Period as provided
in 211 CMR 71.10(7) to provide for the availability of coverage for every
Eligible Person whose Medicare Supplement Insurance Policy or Alternate
Innovative Benefit Rider is canceled or not renewed by reason of such a
rehabilitation, reorganization or liquidation.
(8)
Optional Periodic Open
Enrollment Periods. In addition to the required open enrollment
periods outlined in 211 CMR 71.10(3) through (7), Issuers may hold additional
open enrollment periods at other times of the year for Eligible Persons
provided that each such open enrollment period is of a length of time of not
less than 60 consecutive days. Each Issuer electing to schedule open enrollment
periods under 211 CMR 71.10(8) shall file a statement with the Commissioner
describing the beginning and ending dates for the Issuer's open enrollment
periods. Any open enrollment period held under 211 CMR 71.10(8) must comply
with all of the requirements of
211 CMR 71.00. Each Medicare
Supplement Insurance Policy or Alternate Innovative Benefit Rider currently
available from the Issuer shall be made available to all Eligible Persons who
submit applications during the open enrollment periods held under 211 CMR
71.10(8), except as provided in 211 CMR 71.10(10).
Notwithstanding any other provisions of
211 CMR 71.00, a Medicare
Supplement 1 Insurance Policy may not be offered to Medicare Eligible persons
after January 1, 2020, unless the individual has also:
(a) attained 65 years of age before January
1, 2020; or
(b) first become
eligible for Medicare due to age, disability, or end-stage renal disease before
January 1, 2020. Further notwithstanding any other provisions of
211 CMR 71.00, 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.
(9)
Optional Continuous Open
Enrollment. In addition to the required open enrollment periods
outlined in 211 CMR 71.10(3) through (7), Issuers may elect to maintain
continuous open enrollment for Eligible Persons. Each Issuer electing to
schedule continuous open enrollment under 211 CMR 71.10(9) shall file a
statement with the Commissioner describing the beginning date for the Issuer's
continuous open enrollment. Such statement must be filed with the Commissioner
at least 30 days prior to the beginning of such continuous open enrollment. Any
Issuer that chooses to cease continuous open enrollment under 211 CMR 71.10(9)
shall notify the Commissioner in writing at least 60 days prior to the ending
date for such continuous open enrollment. Each Issuer shall provide at least 30
days' notice of such open enrollment period and any termination of the open
enrollment period to its Insureds or Members. Any continuous open enrollment
held under 211 CMR 71.10(9) must comply with all of the requirements of
211 CMR 71.00. Each Medicare
Supplement Insurance Policy or Alternate Innovative Benefit Rider currently
available from the Issuer shall be made available to all Eligible Persons who
submit applications during the continuous open enrollment held under 211 CMR
71.10(9), except as provided in 211 CMR 71.10(10).
Notwithstanding any other provisions of
211 CMR 71.00, a Medicare
Supplement 1 Insurance Policy may not be offered to Medicare Eligible persons
unless the individual has also:
(a)
attained 65 years of age before January 1, 2020; or
(b) first become eligible for Medicare due to
age, disability or end-stage renal disease, before January 1, 2020. Further
notwithstanding any other provisions of
211 CMR 71.00, 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.
(10) Notwithstanding the provisions in 211
CMR 71.10(3) through (9), an Issuer participating in the market for Medicare
Supplement Insurance that only has available Certificate forms for issuance in
Massachusetts that are issued under one or more group Medicare Supplement
Insurance Policies, and which does not have available Medicare Supplement
Insurance Policy forms for issuance to individuals in Massachusetts, shall not
be required to issue a Medicare Supplement Insurance Policy to an Eligible
Person who is not a member and is not eligible to be a member of the group or
groups to which the Issuer has issued the group Medicare Supplement Insurance
Policy or Policies; provided however, that requirements to become a member in
the group or groups are not based on health status, claims experience, receipt
of health care or medical condition. Notwithstanding 211 CMR 71.10(10), a
Medicare Supplement 1 Insurance Policy may not be offered to Medicare Eligible
Persons if the individual has not also:
(a)
attained 65 years of age before January 1, 2020; or
(b) first become eligible for Medicare due to
age, disability, or end-stage renal disease before January 1, 2020.
(11)
Required Open
Enrollment Period Due to Entry into Market. In the event that
during the months of February through November an Issuer enters the market for
Medicare Supplement Insurance and is unable to participate in the full
two-month required annual open enrollment period specified in 211 CMR 71.10(5)
held during the calendar year of the entry into the market, the Issuer shall
hold a special open enrollment period upon entry into the market. Such special
open enrollment period shall conform to the requirements of the required annual
open enrollment period set forth in 211 CMR 71.10(5), except those pertaining
to the starting date for the open enrollment period, subject to the
Commissioner's approval. For the purposes of 211 CMR 71.10(11), "enters the
market" shall mean that the Issuer is offering, selling, issuing, delivering,
or otherwise making effective a Medicare Supplement Insurance Policy or
Alternate Innovative Benefit Rider in compliance with
211 CMR 71.00 either:
(a) for the first time; or
(b) upon reentry into the market in
accordance with
211
CMR 71.22(3).
(12)
Guaranteed Issue
for Eligible Persons under Section 4031 of the Federal Balanced Budget Act of
1997, Section 501(a)(1) of the Federal Balanced Budget Refinement Act of 1999
and Benefit Improvement and Patient Protection Act of 2000.
(a)
Guaranteed
Issue.
1. An Eligible Person, as
defined by
211 CMR 71.03, who is
an eligible person under Section 4031 of the federal Balanced Budget Act of
1997 (BBA Eligible Person) and Section 501(a)(2) of the federal Balanced Budget
Refinement Act of 1999, are those individuals described in 211 CMR
71.10(12)(b), who seek to enroll under the Policy during the period specified
in 211 CMR 71.10(12)(c) and who submit evidence of the date of termination or
disenrollment with the application for a Medicare Supplement Insurance
Policy.
2. With respect to BBA
Eligible Persons, an issuer shall not deny or condition the issuance or
effectiveness of a Medicare Supplement Insurance Policy described in 211 CMR
71.10(12)(e) that is offered and is available for issuance to new enrollees by
the issuer, except as set forth in 211 CMR 71.10(12)(a)3., shall not
discriminate in the pricing of such a Medicare Supplement Insurance Policy
because of health status, claims experience, receipt of health care, or medical
condition, and shall not impose an exclusion of benefits based on a preexisting
condition under such a Medicare Supplement Insurance Policy.
3. If a BBA Eligible Person also meets the
requirements of being Initially Eligible for Coverage, as defined in
211 CMR 71.03, and if
the individual has also:
a. attained 65 years
of age before January 1, 2020; or
b. first become eligible for Medicare due to
age, disability, or end-stage renal disease before January 1, 2020, then the
individual shall be entitled to guarantee issue of all plans currently
available from an Issuer as specified in 211 CMR 71.10(4), including the time
periods specified. If a BBA Eligible Person also meets the requirements of
being Initially Eligible for Coverage, as defined in
211 CMR 71.03, but if
the individual has not:
(i) attained 65 years
of age before January 1, 2020; or
(ii) first become eligible for Medicare due
to age, disability, or end-stage renal disease before January 1, 2020, then the
individual shall be entitled to guarantee issue of all plans currently
available from an Issuer as specified in 211 CMR 71.10(4), including the time
periods specified, except for Medicare Supplement 1 plans, for which such
persons are not eligible.
(b)
BBA Eligible
Person. A BBA Eligible Person is an individual who meets the
definition of Eligible Person found in
211 CMR 71.03 and who
is described in any of the following paragraphs:
1. The individual is enrolled under an
Employee Welfare Benefit Plan that provides health benefits that supplement the
benefits under Medicare; and the plan terminates, or the plan ceases to provide
all such supplemental health benefits to the individual;
2. The individual is enrolled with a Medicare
Advantage organization under a Medicare Advantage plan under part C of
Medicare, and any of the following circumstances apply, or the individual is 65
years of age or older and is enrolled with a Program of All Inclusive Care for
the Elderly (PACE) provider under the Social Security Act § 1894, and
there are circumstances similar to those described below that would permit
discontinuance of the individual's enrollment with such provider if such
individual were enrolled in a Medicare Advantage plan:
a. The certification of the organization or
plan under this part has been terminated; or
b. The organization has terminated or
otherwise discontinued providing the plan in the area in which the individual
resides;
c. The individual is no
longer eligible to elect the plan because of a change in the individual's place
of residence or other change in circumstances specified by the Secretary, but
not including termination of the individual's enrollment on the basis described
in the federal Social Security Act § 1851(g)(3)(B) (where the individual
has not paid premiums on a timely basis or has engaged in disruptive behavior
as specified in standards under the federal Social Security Act § 1856),
or the plan is terminated for all individuals within a residence
area;
d. The individual
demonstrates, in accordance with guidelines established by the Secretary, that:
i. The organization offering the plan
substantially violated a material provision of the organization's contract
under this part in relation to the individual, including the failure to provide
an enrollee on a timely basis medically necessary care for which benefits are
available under the plan or the failure to provide such covered care in
accordance with applicable quality standards;
ii. The organization, or agent or other
entity acting on the organization's behalf, materially misrepresented the
plan's provisions in marketing the plan to the individual; or
iii. The individual meets such other
exceptional conditions as the Secretary may provide.
3.
a.
The individual is enrolled with:
i. An eligible organization under a contract
under the federal Social Security Act § 1876 (Medicare Cost);
ii. A similar organization operating under
demonstration project authority, effective for periods before April 1,
1999;
iii. An organization under an
agreement under the federal Social Security Act § 1833(a)(1)(A) (health
care prepayment plan); or
iv. An
organization under a Medicare Select Policy; and
b. The enrollment ceases under the same
circumstances that would permit discontinuance of an individual's election of
coverage under 211 CMR 71.10(12)(b)2.
4. The individual is enrolled under a
Medicare Supplement Insurance Policy and the enrollment ceases because:
a.
i. Of
the insolvency of the Issuer or bankruptcy of the nonissuer organization; or
ii. Of other involuntary
termination of coverage or enrollment under the Policy;
b. The Issuer of the Policy substantially
violated a material provision of the Policy; or
c. The Issuer, or an agent or other entity
acting on the Issuer's behalf, materially misrepresented the Policy's
provisions in marketing the Policy to the individual;
5.
a. The
individual was enrolled under a Medicare Supplement Insurance Policy and
terminates enrollment and subsequently enrolls, for the first time, with any
Medicare Advantage organization under a Medicare Advantage plan under part C of
Medicare, any eligible organization under a contract under the federal Social
Security Act § 1876 (Medicare Cost), any similar organization operating
under demonstration project authority, any PACE provider under the federal
Social Security Act § 1894 or a Medicare Select Policy; and
b. The subsequent enrollment under 211 CMR
71.10(12)(b)5.a. is terminated by the enrollee during any period within the
first 12 months of such subsequent enrollment (during which the enrollee is
permitted to terminate such subsequent enrollment under the federal Social
Security Act § 1851(e)).
6. The individual, upon first becoming
eligible for benefits under part A of Medicare at 65 years of age, enrolls in a
Medicare Advantage plan under part C of Medicare or in a PACE program under the
federal Social Security Act § 1894, and disenrolls from the plan or
program by not later than 12 months after the effective date of enrollment.
(c)
Guaranteed Issue Time Periods.
1. In the case of an individual as described
in 211 CMR 71.10(12)(b)1., the guaranteed issue period begins on the date of
the individual receives a notice of termination or cessation of all
supplemental health benefits (or, if such notice is not received, notice that a
claim has been denied because of such a termination or cessation) and ends 63
days after the date of the applicable notice;
2. In the case of an individual described in
211 CMR 71.10(12)(b)2., 3., 5.a., or 6. whose enrollment is terminated
involuntarily, the guaranteed issue period begins on the date that the
individual receives a notice of termination and ends 63 days after the date the
applicable coverage is terminated;
3. In the case of an individual described in
211 CMR 71.10(12)(b)4.a. the guaranteed issue period begins on the earlier of:
a. the date that the individual receives a
notice of termination, a notice of the issuers bankruptcy or insolvency, or
other such similar notice, if any; and
b. the date that the applicable coverage is
terminated, and ends 63 days after the coverage is terminated;
4. In the case of an individual
described in 211 CMR 71.10(12)(b)2., 4.b., 4.c., 5.a. or 6. who disenrolls
voluntarily, the guaranteed issue period begins on the date that is 60 days
before the effective date of the disenrollment and ends 63 days after the
effective date; and
5. In the case
of an individual described in 211 CMR 71.10(12)(b), but not described in the
preceding provisions of 211 CMR 71.10(12)(c), the guaranteed issue period
begins on the effective date of disenrollment and ends on the date that is 63
days after the effective date.
(d)
Extended Medigap Access for
Interrupted Trial Periods.
1. In
the case of an individual described in 211 CMR 71.10(12)(b)5. (or deemed to be
so described, pursuant to 211 CMR 71.10(12)(d)) whose enrollment with an
organization or provider described in 211 CMR 71.10(12)(b)5.a. involuntarily
terminated within the first 12 months of enrollment, and who, without an
intervening enrollment, enrolls with another such organization or provider, the
subsequent enrollment shall be deemed to be an initial enrollment described in
211 CMR 71.10(12)(b)5.
2. In the
case of an individual described in 211 CMR 71.10(12)(b)6. (or deemed to be so
described, pursuant to 211 CMR 71.10(12)(d)) whose enrollment with a plan or in
a program described in 211 CMR 71.10(12)(b)6. is involuntarily terminated
within the first 12 months of enrollment, and who, without an intervening
enrollment, enrolls in another plan or program, the subsequent enrollment shall
be deemed to be an initial enrollment described in 211 CMR
71.10(12)(b)6.
3. For purposes of
211 CMR 71.10(12)(b)5. and 6., no enrollment of an individual with an
organization or provider described in 211 CMR 71.10(12)(b)5.a., or with a plan
or in a program described in 211 CMR 71.10(12)(b)6., may be deemed to be an
initial enrollment under 211 CMR 71.10(12)(d) after the two-year period
beginning on the date on which the individual first enrolled with such
organization, provider, plan, or program.
(e)
Products to Which BBA
Eligible Persons are Entitled. The Medicare Supplement Insurance
Policy to which BBA eligible persons are entitled under:
1. 211 CMR 71.10(12)(b)1., 2., 3. and 4. is a
Medicare Supplement Core Insurance Policy or a Medicare Supplement 1 Insurance
Policy offered by any Issuer if the individual has also:
a. attained 65 years of age before January 1,
2020; or
b. first become eligible
for Medicare due to age, disability, or end-stage renal disease before January
1, 2020. If the individual has not:
(i)
attained 65 years of age before January 1, 2020; or
(ii) first become eligible for Medicare due
to age, disability, or end-stage renal disease before January 1, 2020, then the
individual shall be entitled to all plans currently available from an Issuer as
specified in 211 CMR 71.10(4), except for Medicare Supplement 1
plans.
2.
a. 211 CMR 71.10(12)(b)5. is the same
Medicare Supplement Insurance Policy in which the individual was most recently
previously enrolled, if available from the same Issuer or, if not so available,
a Policy described in 211 CMR 71.10(12)(e)1.
b. After December 31, 2005, if the individual
was most recently enrolled in a Medicare Supplement Insurance Policy with an
outpatient prescription drug benefit, a Medicare Supplement Insurance Policy is
a Medicare Supplement Core Insurance Policy, Medicare Supplement 1 Insurance
Policy, or a Medicare Select Insurance Policy offered by any insurer if the
individual has also:
(i) attained 65 years of
age before January 1, 2020; or
(ii)
first become eligible for Medicare due to age, disability, or end-stage renal
disease before January 1, 2020. If the individual has not:
i. attained 65 years of age before January 1,
2020; or
ii. first become eligible
for Medicare due to age, disability, or end-stage renal disease before January
1, 2020, then the individual shall be entitled to all plans currently available
from an Issuer as specified in 211 CMR 71.10(4), except for Medicare Supplement
1 plans.
3. 211 CMR 71.10(12)(b)6. shall include any
Medicare Supplement Insurance Policy offered by any Issuer if the individual
has also:
a. attained 65 years of age before
January 1, 2020; or
b. first become
eligible for Medicare due to age, disability, or end-stage renal disease before
January 1, 2020. If the individual has not:
(i) attained 65 years of age before January
1, 2020; or
(ii) first become
eligible for Medicare due to age, disability, or end-stage renal disease before
January 1, 2020, then the individual shall be entitled to all plans currently
available from an Issuer as specified in 211 CMR 71.10(4), except Medicare
Supplement 1 plans.
(f)
Notification
Provisions.
1. At the time of an
event described in 211 CMR 71.10(12)(b) because of which an individual loses
coverage or benefits due to the termination of a contract or agreement, Policy,
or plan, the organization that terminates the contract or agreement, the Issuer
terminating the Policy, or the administrator of the plan being terminated,
respectively, shall notify the individual of his or her rights under 211 CMR
71.10(12), and of the obligations of issuers of Medicare Supplement Insurance
Policies under 211 CMR 71.10(12)(a). Such notice shall be communicated
contemporaneously with the notification of termination.
2. At the time of an event described in 211
CMR 71.10(12)(b) because of which an individual ceases enrollment under a
contract or agreement, Policy, or plan, the organization that offers the
contract or agreement, regardless of the basis for the cessation of enrollment,
the Issuer offering the Policy, or the administrator of the plan, respectively,
shall notify the individual of his or her rights under 211 CMR 71.10(12)(f),
and of the obligations of issuers of Medicare Supplement Insurance Policies
under 211 CMR 71.10(12)(a). Such notice shall be communicated within ten
working days of the Issuer receiving notification of disenrollment.
(13)
Guaranteed Coverage for Eligible Persons Consistent with the
MMA.
(a)
Guaranteed
Coverage.
1. Eligible Persons, as
defined by
211 CMR 71.03, who
are eligible persons under the MMA, are those individuals described in 211 CMR
71.10(13)(b), who seek to enroll under the Policy during the period specified
in 211 CMR 71.10(13)(c) and who submit evidence of enrollment in Medicare Part
D along with the application for a Medicare Supplement Insurance
Policy.
2. With respect to MMA
Eligible Persons, an Issuer shall not deny or condition the coverage or
effectiveness of a Medicare Supplement Insurance Policy described in 211 CMR
71.10(13)(d), shall not discriminate in the pricing of such a Medicare
Supplement Insurance Policy because of health status, claims experience,
receipt of health care, or medical condition, and shall not impose an exclusion
of benefits based on a preexisting condition under such a Medicare Supplement
Insurance Policy.
3. If MMA
Eligible Persons also meet the requirements of being Initially Eligible for
Coverage, as defined in
211 CMR 71.03, the
individuals shall be entitled to guaranteed coverage under all Policies
currently available from an Issuer as specified in 211 CMR 71.10(4), including
the time periods specified.
(b)
MMA Eligible
Person. MMA Eligible Persons are individuals who meet the
definition of Eligible Person found in
211 CMR 71.03 and who
enroll in a Medicare Part D plan during the initial enrollment period and, who
at the time of enrollment in Part D,
1. were
enrolled under a Medicare Supplement Insurance Policy with an outpatient
prescription drug benefit; and
2.
terminate enrollment in that Medicare Supplement Insurance Policy;
and
3. submit evidence of
enrollment in Medicare Part D along with the application for a Policy described
in 211 CMR 71.10(13)(d).
(c)
Guaranteed Coverage Time
Periods. In the case of an individual described in 211 CMR
71.10(13)(b), the guaranteed coverage period begins on the date the individual
receives notice pursuant to the federal Social Security Act §
1882(v)(2)(B) from the Medicare Supplement Insurance Issuer during the 60-day
period immediately preceding the initial Part D enrollment period and ends on
the date that is 63 days after the effective date of the individual's coverage
under Medicare Part D.
(d)
Products to Which MMA Eligible Persons are Entitled.
The Medicare Supplement Insurance Policy to which MMA Eligible Persons are
entitled under 211 CMR 71.10(13)(b) is a Medicare Supplement Core Insurance
Policy, or a Medicare Supplement 1 Insurance Policy from the same Issuer that
issued the individual's Medicare Supplement Insurance Policy with outpatient
prescription drug coverage. In the event that an Issuer has never issued a
Medicare Supplement Core Insurance Policy or a Medicare Supplement 1 Insurance
Policy, the Medicare Supplement Insurance Policy to which MMA Eligible Persons
are entitled under 211 CMR 71.10(13)(b) is any Medicare Supplement Insurance
Policy without outpatient prescription drug coverage from the same Issuer that
issued the individual's Medicare Supplement Insurance Policy with outpatient
prescription drug coverage.
