Current through Register Vol. 63, No. 9, September 1, 2024
(1) An issuer shall
not deliver or issue for delivery a policy or certificate to a resident of this
state unless the policy form or certificate form has been filed with and
approved by the Director in accordance with filing requirements and procedures
prescribed by the Director.
(2) An
issuer shall file any riders or amendments to policy or certificate forms to
delete outpatient prescription drug benefits as required by the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 only with the
Insurance Commissioner in the state in which the policy or certificate was
issued.
(3)
(a) An issuer shall not use or change premium
rates for a Medicare supplement policy or certificate unless the rates, rating
schedule and supporting documentation have been filed with and approved by the
Director in accordance with filing requirements and procedures prescribed by
the Director.
(b) Except for an
adjustment of premium on the basis of attained age under OAR
836-052-0138, an issuer may not
increase the rates for a Medicare supplement policy or certificate issued in
this state more than once in a 12-month period. Annual rate increases shall be
effective on the policy or certificate anniversary date or renewal date. If an
issuer intends to exercise the right to adjust a premium for age attainment
under OAR 836-052-0138, and such
adjustment results in more than one increase in a 12-month period, the issuer
must provide written disclosure to the consumer prior to the issuance of the
policy or certificate. The limitation on premium adjustments under this
subsection does not apply to a premium adjustment that results from a change in
the policy or premium payment terms requested by an insured including but not
limited to changes in the method of payment such as discontinuing payment by a
preauthorized electronic funds transfer.
(4) Except as provided in this section, an
issuer shall not file for approval more than one form of a policy or
certificate of each type for each standard Medicare supplement benefit plan.
For the purposes of this section, a "type" means an individual policy or a
group policy. An issuer may offer, with the approval of the Director, not more
than four additional policy forms or certificate forms of the same type for the
same standard Medicare supplement benefit plan, one for each of the following
cases:
(a) The inclusion of new or innovative
benefits;
(b) The addition of
either direct response or agent marketing methods;
(c) The addition of either guaranteed issue
or underwritten coverage.
(5) The following applies to continuance and
discontinuance of Medicare supplement policies and certificates:
(a) Except as provided in this subsection, an
issuer shall continue to make available for purchase any policy form or
certificate form issued after July 1, 1992, that has been approved by the
Director. A policy form or certificate form shall not be considered to be
available for purchase unless the issuer has actively offered it for sale in
the previous twelve months. The following applies to discontinuance of a policy
form or certificate form to which this subsection applies:
(A) An issuer may discontinue the
availability of a policy form or certificate form for new issues if the issuer
provides to the Director in writing its decision at least 30 days prior to
discontinuing the availability of the form of the policy or certificate. After
receipt of the notice by the Director, the issuer shall no longer offer for
sale the policy form or certificate form in this state. The issuer must
continue to renew outstanding policies and certificates;
(B) An issuer that discontinues the
availability of a policy form or certificate form pursuant to paragraph (A) of
this subsection shall not file for approval a new policy form or certificate
form of the same type for the same standard Medicare supplement benefit plan as
the discontinued form for a period of five years after the issuer provides
notice to the Director of the discontinuance. The period of discontinuance may
be reduced if the Director determines that a shorter period is
appropriate.
(b) The
sale or other transfer of Medicare supplement business to another issuer shall
be considered a discontinuance for the purposes of this subsection;
(c) A change in the rating structure or
methodology shall be considered a discontinuance under subsection (a) of this
section unless the issuer complies with the following requirements:
(A) The issuer provides an actuarial
memorandum satisfactory to the Director, in a form and manner prescribed by the
Director, describing the manner in which the revised rating methodology and
resultant rates differ from the existing rating methodology and existing
rates;
(B) The issuer does not
subsequently put into effect a change of rates or rating factors that would
cause the percentage differential between the discontinued and subsequent rates
as described in the actuarial memorandum to change. The Director may approve a
change to the differential that is in the public interest.
(6) Except as provided in this
section, the experience of all policy forms or certificate forms of the same
type in a standard Medicare supplement benefit plan shall be combined for
purposes of the refund or credit calculation prescribed in OAR
836-052-0145. Forms assumed
under an assumption reinsurance agreement shall not be combined with the
experience of other forms for purposes of the refund or credit
calculation.
Stat. Auth.: ORS
743.683
Stats. Implemented: ORS
743.010,
743.684(1)-(2)
& 743.683(2)
