Regl. 7747, art. L-11
Open Enrollment
Length: 330 wordsOfficial source
Cite as Reglamento Núm. 7747, Art. L-11
A.
An issuer shall not deny or condition the issuance or effectiveness of any
Medicare supplement policy or certificate available for sale in Puerto Rico,
nor discriminate in the pricing of a policy or certificate because of the
health status, claims experience, receipt of health care, or medical
condition of an applicant in the case of an application for a policy or
certificate that is submitted prior to or during the six (6) month period
beginning with the first day of the first month in which an individual is
both 65 years of age or older and is enrolled for benefits under Medicare
Part B. Each Medicare supplement policy and certificate currently
available from an insurer shall be made available to all applicants who
qualify under this subsection without regard to age.
B.
(1)
If an applicant qualifies under Subsection A and submits an
application during the time period referenced in Subsection A and
as of the date of application, has had a continuous period of
creditable coverage of at least six (6) months, the issuer shall not
exclude benefits based on a preexisting condition.
(2)
If the applicant qualifies under Subsection A and submits an
application during the time period referenced in Subsection A and,
as of the date of application, has had a continuous period of
creditable coverage that is less than six (6) months, the issuer shall
reduce the period of any preexisting condition exclusion by the
aggregate of the period of creditable coverage applicable to the
applicant as of the enrollment date. The Secretary shall specify the
manner of the reduction under this subsection.
C.
Except as provided in Subsection B and Sections 12 and 23, Subsection A
shall not be construed as preventing the exclusion of benefits under a
policy, during the first six (6) months, based on a preexisting condition for
which the policyholder or certificate holder received treatment or was
otherwise diagnosed during the six (6) months before the coverage
became effective.
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