Policies not to duplicate benefits provided by Medicare--preexistingconditions, limitations on--director to issue rules establishingstandards.
376.864. 1. No Medicare supplement policy or certificate in force inthe state shall contain benefits that duplicate benefits provided by Medicare.
2. Notwithstanding any other provision of law to the contrary, aMedicare supplement policy or certificate shall not exclude or limit benefitsfor losses incurred more than six months from the effective date of coveragebecause it involved a preexisting condition. The policy or certificate shallnot define a preexisting condition more restrictively than a condition forwhich medical advice was given or treatment was recommended by or receivedfrom a physician within six months before the effective date of coverage.
3. The director shall adopt reasonable regulations to establish specificstandards for policy provisions of Medicare supplement policies andcertificates. Such standards shall be in addition to and in accordance withapplicable laws of this state, including sections 376.770 to 376.800. Norequirement of the insurance laws relating to minimum required policybenefits, other than the minimum standards contained in sections 376.850 to376.890, shall apply to Medicare supplement policies and certificates. Thestandards may cover, but not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
4. The director may adopt from time to time such reasonable regulationsas are necessary to conform Medicare supplement policies and certificates tothe requirements of federal law and regulations promulgated thereunder,including but not limited to:
(1) Requiring refunds or credits if the policies or certificates do notmeet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reportingloss ratios;
(3) Assuring public access to policies, premiums and loss ratioinformation of issuers of Medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy formsand certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approvalof premium increases; and
(6) Establishing standards for Medicare select policies andcertificates.
5. The director may adopt reasonable regulations that specify prohibitedpolicy provisions not otherwise specifically authorized by statute which, inthe opinion of the director, are unjust, unfair or unfairly discriminatory toany person insured or proposed to be insured under a Medicare supplementpolicy or certificate.
Policies not to duplicate benefits provided by Medicare--preexistingconditions, limitations on--director to issue rules establishingstandards.
376.864. 1. No Medicare supplement policy or certificate in force inthe state shall contain benefits that duplicate benefits provided by Medicare.
2. Notwithstanding any other provision of law to the contrary, aMedicare supplement policy or certificate shall not exclude or limit benefitsfor losses incurred more than six months from the effective date of coveragebecause it involved a preexisting condition. The policy or certificate shallnot define a preexisting condition more restrictively than a condition forwhich medical advice was given or treatment was recommended by or receivedfrom a physician within six months before the effective date of coverage.
3. The director shall adopt reasonable regulations to establish specificstandards for policy provisions of Medicare supplement policies andcertificates. Such standards shall be in addition to and in accordance withapplicable laws of this state, including sections 376.770 to 376.800. Norequirement of the insurance laws relating to minimum required policybenefits, other than the minimum standards contained in sections 376.850 to376.890, shall apply to Medicare supplement policies and certificates. Thestandards may cover, but not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
4. The director may adopt from time to time such reasonable regulationsas are necessary to conform Medicare supplement policies and certificates tothe requirements of federal law and regulations promulgated thereunder,including but not limited to:
(1) Requiring refunds or credits if the policies or certificates do notmeet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reportingloss ratios;
(3) Assuring public access to policies, premiums and loss ratioinformation of issuers of Medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy formsand certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approvalof premium increases; and
(6) Establishing standards for Medicare select policies andcertificates.
5. The director may adopt reasonable regulations that specify prohibitedpolicy provisions not otherwise specifically authorized by statute which, inthe opinion of the director, are unjust, unfair or unfairly discriminatory toany person insured or proposed to be insured under a Medicare supplementpolicy or certificate.
Policies not to duplicate benefits provided by Medicare--preexistingconditions, limitations on--director to issue rules establishingstandards.
376.864. 1. No Medicare supplement policy or certificate in force inthe state shall contain benefits that duplicate benefits provided by Medicare.
2. Notwithstanding any other provision of law to the contrary, aMedicare supplement policy or certificate shall not exclude or limit benefitsfor losses incurred more than six months from the effective date of coveragebecause it involved a preexisting condition. The policy or certificate shallnot define a preexisting condition more restrictively than a condition forwhich medical advice was given or treatment was recommended by or receivedfrom a physician within six months before the effective date of coverage.
3. The director shall adopt reasonable regulations to establish specificstandards for policy provisions of Medicare supplement policies andcertificates. Such standards shall be in addition to and in accordance withapplicable laws of this state, including sections 376.770 to 376.800. Norequirement of the insurance laws relating to minimum required policybenefits, other than the minimum standards contained in sections 376.850 to376.890, shall apply to Medicare supplement policies and certificates. Thestandards may cover, but not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
4. The director may adopt from time to time such reasonable regulationsas are necessary to conform Medicare supplement policies and certificates tothe requirements of federal law and regulations promulgated thereunder,including but not limited to:
(1) Requiring refunds or credits if the policies or certificates do notmeet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reportingloss ratios;
(3) Assuring public access to policies, premiums and loss ratioinformation of issuers of Medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy formsand certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approvalof premium increases; and
(6) Establishing standards for Medicare select policies andcertificates.
5. The director may adopt reasonable regulations that specify prohibitedpolicy provisions not otherwise specifically authorized by statute which, inthe opinion of the director, are unjust, unfair or unfairly discriminatory toany person insured or proposed to be insured under a Medicare supplementpolicy or certificate.
