Current through Register Vol. XLI, No. 38, September 20, 2024
13.1. 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 Commissioner in
accordance with filing requirements and procedures prescribed by the
Commissioner.
13.2. 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 commissioner in the state
in which the policy or certificate was issued.
13.3. 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
Commissioner in accordance with the filing requirements and procedures prescribed by
the Commissioner.
13.4. Except as
provided in subdivision a of this subsection, 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.
13.4.a. An
issuer may offer, with the approval of the Commissioner, up to 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:
13.4.a.1. The inclusion of new or innovative
benefits;
13.4.a.2. The addition of
either direct response or agent marketing methods;
13.4.a.3. The addition of either guaranteed issue
or underwritten coverage;
13.4.a.4. The
offering of coverage to individuals eligible for Medicare by reason of
disability.
13.4.b. For the
purposes of this section, a "type" means an individual policy, a group policy, an
individual Medicare Select policy, or a group Medicare Select policy.
13.5. Except as provided in paragraph 1
of subdivision a of this subsection, an issuer shall continue to make available for
purchase any policy form or certificate form issued after the effective date of this
rule that has been approved by the Commissioner.
13.5.a. 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.
13.5.a.1. An issuer may discontinue the
availability of a policy form or certificate form if the issuer provides to the
Commissioner in writing its decision at least thirty (30) days prior to
discontinuing the availability of the form of the policy or certificate. After
receipt of the notice by the Commissioner, the issuer shall no longer offer for sale
the policy form or certificate form in this state.
13.5.a.2. An issuer that discontinues the
availability of a policy form or certificate form pursuant to paragraph 1 of
subdivision 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 (5) years after the issuer
provides notice to the Commissioner of the discontinuance. The period of
discontinuance may be reduced if the Commissioner determines that a shorter period
is appropriate.
13.5.b. The
sale or other transfer of Medicare supplement business to another issuer shall be
considered a discontinuance for the purposes of this subsection.
13.5.c. A change in the rating structure or
methodology shall be considered a discontinuance under this subsection unless the
issuer complies with the following requirements:
13.5.c.1. The issuer provides an actuarial
memorandum, in a form and manner prescribed by the Commissioner, describing the
manner in which the revised rating methodology and resultant rates differ from the
existing rating methodology and existing rates.
13.5.c.2. 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 Commissioner may approve a change to the
differential which is in the public interest.
13.6. Refund or Credit Calculation.
13.6.a. Except as provided in subdivision b of
this subsection, 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 section 12 of this rule.
13.6.b. 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.
13.7. An issuer shall not present for filing or
approval a rate structure for its Medicare supplement policies or certificates
issued after the effective date of the amendment of this rule based upon a structure
or methodology with any groupings of attained ages greater than one year. The ratio
between rates for successive ages shall increase smoothly as age increases. For any
insurer that rates Medicare supplement policies or certificates under multiple-year
age banding at the time of the effective date of this subsection, the insurer may
transition to one-year age bands over a period of five (5) years or less. Nothing
herein shall prohibit an insurer from applying a maximum rate based upon the
attainment of a specific age.
