Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan

Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued For Delivery After July 1, 1992 With An Effective Date For Coverage Prior To June 1, 2010 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after July 1, 1992 and with an effective date for coverage prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. A. General Standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this regulation. 1. 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 may 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. 2. A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents. 3. A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, co-payment, or coinsurance amounts. Premiums may be modified to correspond with such changes. 4. No Medicare supplement policy or certificate shall provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium. 5. Each Medicare supplement policy shall be guaranteed renewable. a. The issuer shall not cancel or non-renew the policy solely on the ground of health status of the individual. b. The issuer shall not cancel or non-renew the policy for any reason other than nonpayment of premium or material misrepresentation. c. If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under Rule 10.08A(5)(e), the issuer shall offer certificate holders an individual Medicare supplement policy which (at the option of the certificate holder) i. Provides for continuation of the benefits contained in the group policy, or ii. Provides for benefits that otherwise meet the requirements of this subsection. d. If an individual is a certificate holder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall: i. Offer the certificate holder the conversion opportunity described in