Current through Register Vol. 41, No. 3, September 23, 2024
A. Effective 60 days after enactment of
federal law mandating Medicare benefit changes, no Medicare supplement
insurance policy, contract, or certificate subject to this chapter, in effect
on the effective date of this chapter (14VAC5-150-10 et seq.) shall
contain benefits which duplicate benefits provided by Medicare.
B. General requirements.
1. On the later of:
a. Thirty days prior to the effective date of
Medicare benefit changes, or
b.
Sixty days after enactment of federal law mandating Medicare benefit changes,
every insurer, health services plan, health maintenance
organization or other entity providing Medicare supplement insurance or
benefits shall notify its policyholders, contract holders, and certificate
holders of modifications it has made to Medicare supplement insurance policies
or contracts. Such notice shall be in a format prescribed in Exhibit A and be
written in outline form in clear and simple terms so as to facilitate
comprehension. Such notice shall not contain or be accompanied by any
solicitation.
2.
No modifications to an existing Medicare supplement contract or policy shall be
made at the time of or in connection with the notice requirements of this
chapter except to the extent necessary to eliminate duplication of Medicare
benefits and any modifications necessary under the policy or contract to
provide indexed benefit adjustment.
3. As soon as practicable, but no longer than
60 days after the effective date of the Medicare benefit changes, every
insurer, health services plan, health maintenance organization or other entity
providing Medicare supplement insurance or contracts in this Commonwealth shall
file with the Commission, in accordance with the applicable filing procedures
of this Commonwealth:
a. Appropriate premium
adjustments necessary to produce loss ratios as originally anticipated for the
applicable policies or contracts. Such supporting documents as necessary to
justify the adjustment shall accompany the filing.
b. Any appropriate riders, endorsements, or
policy forms needed to accomplish the Medicare supplement insurance
modifications necessary to eliminate benefit duplications with Medicare. Any
such riders, endorsements, or policy forms shall provide a clear description of
the medicare supplement benefits provided by the policy or contract.
4. Upon satisfying the filing and
approval requirements of this Commonwealth, every insurer, health services
plan, health maintenance organization or other entity providing Medicare
supplement insurance shall provide each covered person with any rider,
endorsement or policy form necessary to eliminate any benefit duplications
under the policy or contract with benefits provided by Medicare.
5. No insurer, health services plan, health
maintenance organization or other entity shall require any person covered under
a Medicare supplement policy or contract which was in effect on August 31,
1988, to purchase additional coverage under such policy or contract unless such
additional coverage was provided for in the policy contract.
6. Every insurer, health services plan,
health maintenance organization or other entity providing Medicare supplement
insurance shall make such premium adjustments as are necessary to produce an
expected loss ratio under such policy or contract as will conform with minimum
loss ratio standards for Medicare supplement policies and which is expected to
result in a loss ratio at least as great as that originally anticipated by the
insurer, health services plan, health maintenance organization or other entity
for such medicare supplement insurance policies or contracts. No premium
adjustment which would modify the loss ratio experience under the policy other
than the adjustments described herein should be made with respect to a policy
at any time other than upon its renewal date. Premium adjustments shall be in
the form of refunds or premium credits and shall be made no later than upon
renewal if credit is given, or within 60 days of the renewal date if a refund
is provided to the premium payor.
§§ 38.2-223, 38.2-3516 through 38.2-3520,
38.2-3600 through 38.2-3607 and 38.2-514 of the Code of Virginia.
