Current through Register Vol. 63, No. 9, September 1, 2024
(1) An issuer must comply with Section
1882(c)(3) of the Social Security Act, as enacted by Section 4081(b)(2)(C) of
the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Public Law No.
100-203, by:
(a) Accepting a notice from a
Medicare carrier on dually assigned claims submitted by participating
physicians and suppliers as a claim for benefits in place of any other claim
form otherwise required and making a payment determination on the basis of the
information contained in that notice;
(b) Notifying the participating physician or
supplier and the beneficiary of the payment determination;
(c) Paying the participating physician or
supplier directly;
(d) Furnishing
each enrollee, at the time of enrollment, with a card listing the policy name,
number and a central mailing address to which notices from a Medicare carrier
may be sent;
(e) Paying user fees
for claim notices that are transmitted electronically or otherwise;
and
(f) Providing to the Secretary
of Health and Human Services, at least annually, a central mailing address to
which all claims may be sent by Medicare carriers.
(2) Each insurer providing Medicare
supplement coverage in this state shall, concurrent with the filing of the
Accident and Health Policy Experience Exhibit, file a Medicare Supplement
Insurance Experience Exhibit. The exhibit shall be in a format prescribed by
the Director. The Director may prescribe the format adopted by the National
Association of Insurance Commissioners. The following provisions also apply:
(a) Every insurer providing Medicare
supplement coverage in this state shall file with the Medicare Supplement
Insurance Experience Exhibit a list of its Medicare supplement policies or
certificates offered or issued and outstanding in this state as of the end of
the previous calendar year;
(b) The
list under subsection (a) of this section shall identify the filing insurer by
name and address, shall identify each policy or certificate by name and form
number, and shall differentiate between policies and certificates filed with
and approved by the Director in years prior to the previous calendar year and
those filed and approved in the previous calendar year;
(c) Policies and certificates that are issued
and outstanding in this state but are no longer offered for sale shall be
specifically identified, as shall any policies or certificates that for any
reason were not filed with and approved by the Director;
(d) The list shall include identification of
any policy or certificate for which the Director's approval was withdrawn
within the previous calendar year;
(e) On or before the first day of September
of each year, commencing September 1, 1989, the Director shall provide the
Secretary of Health and Human Services with a list containing the information
required to be submitted by this section and identifying each insurer by name
and address.
(3)
Compliance with the requirements set forth in this rule must be certified by
the insurer on the Medicare supplement insurance experience reporting
form.
Publications: Publications referenced are available from the
agency.
Stat. Auth.: ORS
731.244,
743.010,
743.013,
743.680 -
743.689 &
746.240
Stats. Implemented: ORS
743.683(2)
& 743.683(6)
