19 MAC Pt. 3, R. 10.12B
(2)
Cite as 19 Miss. Admin. Code Pt. 3, R. 10.12B
(2).
4.
The individual is enrolled under a Medicare supplement policy and the enrollment
ceases because:
a. i.
Of the insolvency of the issuer or bankruptcy of the non-issuer
organization; or
ii. Of other involuntary termination of coverage or enrollment under the policy;
b. The issuer of the policy substantially violated a material provision of the policy; or
c. The issuer, or an agent or other entity acting on the issuer's behalf, materially misrepresented
the policy’s provisions in marketing the policy to the individual;
5.
a. The individual was enrolled under a Medicare supplement policy and terminates
enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization
under a Medicare Advantage plan under part C of Medicare, any eligible organization under a
contract under Section 1876 of the Social Security Act (Medicare cost), any similar organization
operating under demonstration project authority, any PACE provider under Section 1894 of the
Social Security Act or a Medicare Select policy; and
b. The subsequent enrollment under subparagraph (a) is terminated by the enrollee during any
period within the first twelve (12) months of such subsequent enrollment (during which the enrollee
is permitted to terminate such subsequent enrollment under Section 1851(e) of the federal Social
Security Act); or
6.
The individual, upon first becoming eligible for benefits under part A of Medicare at
age 65, enrolls in a Medicare Advantage plan under part C of Medicare, or with a PACE provider
under Section 1894 of the Social Security Act, and disenrolls from the plan or program by not later
than twelve (12) months after the effective date of enrollment.
7.
The individual enrolls in a Medicare Part D plan during the initial enrollment period
and, at the time of enrollment in Part D, was enrolled under a Medicare supplement policy that
covers outpatient prescription drugs and the individual terminates enrollment in the Medicare
supplement policy and submits evidence of enrollment in Medicare Part D along with the application
for a policy described in Subsection E(4).
C. Guaranteed Issue Time Periods.
1.
In the case of an individual described in Subsection B(1), the guaranteed issue period
begins on the later of: (i) the date the individual receives a notice of termination or cessation of all
supplemental health benefits (or, if a notice is not received, notice that a claim has been denied
because of a termination or cessation); or (ii) the date that the applicable coverage terminates or
ceases; and ends sixty-three (63) days thereafter;
2.
In the case of an individual described in Subsection B(2), B(3), B(5) or B(6) whose
enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the
individual receives a notice of termination and ends sixty- three (63) days after the date the
applicable coverage is terminated;
3.
In the case of an individual described in Subsection B(4)(a), the guaranteed issue
period begins on the earlier of: (i) the date that the individual receives a notice of termination, a
notice of the issuer’s bankruptcy or insolvency, or other such similar notice if any, and (ii) the date
that the applicable coverage is terminated, and ends on the date that is sixty-three (63) days after the
date the coverage is terminated;
4.
In the case of an individual described in Subsection B(2), B(4)(b), B(4)(c), B(5) or B(6)
who disenrolls voluntarily, the guaranteed issue period begins on the date that is sixty (60) days
before the effective date of the disenrollment and ends on the date that is sixty-three (63) days after
the effective date;
5.
In the case of an individual described in Subsection B(7), the guaranteed issue
period begins on the date the individual receives notice pursuant to Section
1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the sixty-day
period immediately preceding the initial Part D enrollment period and ends on the date that is sixty-
three (63) days after the effective date of the individual’s coverage under Medicare Part D; and
6.
In the case of an individual described in Subsection B but not described in the preceding
provisions of this Subsection, the guaranteed issue period begins on the effective date of
disenrollment and ends on the date that is sixty-three (63) days after the effective date.
D. Extended Medigap Access for Interrupted Trial Periods.
1.
In the case of an individual described in Subsection B(5) (or deemed to be so
described, pursuant to this paragraph) whose enrollment with an organization or provider described
in Subsection B(5)(a) is involuntarily terminated within the first twelve (12) months of enrollment,
and who, without an intervening enrollment, enrolls with another such organization or provider,
the subsequent enrollment shall be deemed to be an initial enrollment described in