Current through Register Vol. 63, No. 9, September 1, 2024
(1)
(a) 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 a policy
or certificate 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 Medicare supplement policy or certificate that is submitted to the issuer
prior to or during the six month period beginning with the first day of the
first month in which an individual is enrolled for benefits under Medicare Part
B. Each Medicare supplement policy and certificate currently available from an
issuer shall be made available on a guaranteed issue basis to all applicants
who qualify under this section without regard to age.
(b) If a person under the age of 65 applies
for enrollment under Medicare Part B due to disability and is initially denied
as ineligible, but upon conclusion of the person's appeals process the person
is awarded retroactive enrollment, the six month period described in this
section begins on the first day of the first month after the person receives
written notice of retroactive enrollment.
(2)
(a) If
an applicant qualifies under section (1) of this rule and submits an
application during the time period referenced in section (1) of this rule and,
as of the date of application, has had a continuous period of creditable
coverage of at least six months, the issuer shall not exclude benefits based on
a preexisting condition;
(b) If the
applicant qualifies under section (1) of this rule and submits an application
during the time period referenced in section (1) of this rule and, as of the
date of application, has had a continuous period of creditable coverage that is
less than six 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. The manner of the
reduction under this subsection shall be the manner prescribed in
42 USC
300gg(a)(3) as of the
effective date of this rule.
(3) Except as provided in section 2 of this
rule and OAR 836-052-0142 and
836-052-0190, section (1) of
this rule shall not be construed as preventing the exclusion of benefits under
a policy, during the first six months, based on a preexisting condition for
which the policyholder or certificate holder received treatment or was
otherwise diagnosed during the six months before the coverage became
effective.
(4) This section applies
to a person who qualifies for Medicare by reason of disability and who obtains
a Medicare supplement policy during the six month period described in section
(1) of this rule. For the period that a person to whom this section applies is
65 years of age or less, the premium charged the person by the issuer shall not
be greater than the premium charged by the issuer for persons who are 65 years
of age. Following that period, for issuers who charge rates on policies on the
basis of attained age, the rating plan shall not differentiate on the basis of
the reason for eligibility for Medicare Part B.
(5) An issuer must comply with section (1) of
this rule with respect to a person:
(a) Who
qualifies for Medicare by reason of disability, who first enrolls for benefits
under Medicare Part B on or after September 1, 1993, and who applies for a
Medicare supplement policy or certificate during the period of eligibility
described in section (1) of this rule;
(b) Who enrolled in Medicare Part B before
attaining 65 years of age, who applies for a Medicare supplement policy or
certificate upon attaining 65 years of age, during the period of eligibility
described in section (1) of this rule that would apply if the person first
enrolled in Medicare Part B upon attaining 65 years of age; or
(c) Who qualifies for Medicare by reason of
disability and has moved to Oregon from a state that does not require Medicare
Supplement policies to be issued to persons under age 65. The guaranteed issue
period begins on the date that the individual establishes residency in Oregon
and ends 63 days thereafter.
Statutory/Other Authority: ORS
743.683
Statutes/Other Implemented: ORS
743.683 & ORS
743.010
