56-7-1453. Contents of policies and certificates Duplicate benefits Preexisting conditions Rules and regulations.
(a) No medicare supplement policy or certificate in force in this state shall contain benefits that duplicate benefits provided by medicare.
(b) Notwithstanding any other law to the contrary, a medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.
(c) The commissioner shall promulgate reasonable rules and regulations to establish specific standards for policy provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this state, including chapter 26 of this title. No requirement of this title relating to minimum required policy benefits, other than the minimum standards contained in §§ 56-7-1451, 56-7-1452, this section and §§ 56-7-1454 56-7-1459, shall apply to medicare supplement policies and certificates. The standards may cover, but are not limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefits limitations, exceptions and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
(d) The commissioner shall promulgate reasonable rules and regulations to establish minimum standards for benefits, claims payment, marketing practices and compensation arrangements and reporting practices for medicare supplement policies and certificates.
(e) The commissioner may promulgate, from time to time, reasonable rules and regulations necessary to conform medicare supplement policies and certificates to the requirements of federal law and regulations promulgated under federal law, including, but not limited to:
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reporting loss ratios;
(3) Assuring public access to policies, premiums and loss ratio information of issuers of medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approval of premium increases; and
(6) Establishing standards for medicare select policies and certificates.
(f) The commissioner shall promulgate reasonable rules and regulations that specify prohibited policy provisions not otherwise specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a medicare supplement policy or certificate.
56-7-1453. Contents of policies and certificates Duplicate benefits Preexisting conditions Rules and regulations.
(a) No medicare supplement policy or certificate in force in this state shall contain benefits that duplicate benefits provided by medicare.
(b) Notwithstanding any other law to the contrary, a medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.
(c) The commissioner shall promulgate reasonable rules and regulations to establish specific standards for policy provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this state, including chapter 26 of this title. No requirement of this title relating to minimum required policy benefits, other than the minimum standards contained in §§ 56-7-1451, 56-7-1452, this section and §§ 56-7-1454 56-7-1459, shall apply to medicare supplement policies and certificates. The standards may cover, but are not limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefits limitations, exceptions and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
(d) The commissioner shall promulgate reasonable rules and regulations to establish minimum standards for benefits, claims payment, marketing practices and compensation arrangements and reporting practices for medicare supplement policies and certificates.
(e) The commissioner may promulgate, from time to time, reasonable rules and regulations necessary to conform medicare supplement policies and certificates to the requirements of federal law and regulations promulgated under federal law, including, but not limited to:
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reporting loss ratios;
(3) Assuring public access to policies, premiums and loss ratio information of issuers of medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approval of premium increases; and
(6) Establishing standards for medicare select policies and certificates.
(f) The commissioner shall promulgate reasonable rules and regulations that specify prohibited policy provisions not otherwise specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a medicare supplement policy or certificate.
56-7-1453. Contents of policies and certificates Duplicate benefits Preexisting conditions Rules and regulations.
(a) No medicare supplement policy or certificate in force in this state shall contain benefits that duplicate benefits provided by medicare.
(b) Notwithstanding any other law to the contrary, a medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six (6) months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage.
(c) The commissioner shall promulgate reasonable rules and regulations to establish specific standards for policy provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this state, including chapter 26 of this title. No requirement of this title relating to minimum required policy benefits, other than the minimum standards contained in §§ 56-7-1451, 56-7-1452, this section and §§ 56-7-1454 56-7-1459, shall apply to medicare supplement policies and certificates. The standards may cover, but are not limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefits limitations, exceptions and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
(d) The commissioner shall promulgate reasonable rules and regulations to establish minimum standards for benefits, claims payment, marketing practices and compensation arrangements and reporting practices for medicare supplement policies and certificates.
(e) The commissioner may promulgate, from time to time, reasonable rules and regulations necessary to conform medicare supplement policies and certificates to the requirements of federal law and regulations promulgated under federal law, including, but not limited to:
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reporting loss ratios;
(3) Assuring public access to policies, premiums and loss ratio information of issuers of medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approval of premium increases; and
(6) Establishing standards for medicare select policies and certificates.
(f) The commissioner shall promulgate reasonable rules and regulations that specify prohibited policy provisions not otherwise specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a medicare supplement policy or certificate.
