Current through September 21, 2024
(a) 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.
(b) 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.
(c) 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.
(d)
Multiple Policy or Type.
(i) Except as
provided in Paragraph (ii) 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.
(ii) An issuer may offer, with the approval
of the commissioner, up to four (4) 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 methods;
(D) The offering of coverage to individuals
eligible for Medicare by reason of disability.
(iii) 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.
(e) Availability and Discontinuance.
(i) Except as provided in Paragraph (i)(A),
an issuer shall continue to make available for purchase any policy form or
certificate form issued after the effective date of this regulation that has
been approved by the commissioner. 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 (12) months.
(A) 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.
(B) An issuer that discontinues the
availability of a policy form or certificate form pursuant to Subparagraph (A)
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.
(ii) The sale or other transfer of
Medicare supplement business to another issuer shall be considered a
discontinuance for the purposes of this subsection.
(iii) A change in the rating structure or
methodology shall be considered a discontinuance under Paragraph (i) unless the
issuer complies with the following requirements:
(A) 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.
(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 commissioner may approve a change to the
differential that is in the public interest.
(f) Combination of Forms or Certificates.
(i) Except as provided in Paragraph (ii), 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
14(b)(iv).
(ii) 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.
(g) 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 regulation 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.
