Regl. 7747, art. L-8.1B
of this rule.
Length: 506 wordsOfficial source
Cite as Reglamento Núm. 7747, Art. L-8.1B
(c)
If membership in a group is terminated, the issuer,
shall:
(i)
Offer the certificate holder the conversion
opportunities described in Subparagraph (b);
or
(ii)
At the option of the group policyholder, offer
the certificate holder continuation of coverage
under the group policy.
(d)
If a group Medicare supplement policy is replaced by
another group Medicare supplement policy purchased
by the same policyholder, the issuer of the
replacement policy shall offer coverage to all persons
covered under the old group policy on its date of
termination. Coverage under the new group policy
shall not result in any exclusion for preexisting
conditions that would have been covered under the
group policy being replaced.
(6)
Termination of a Medicare supplement policy or certificate
shall be without prejudice to any continuous loss which
commenced while the policy was in force, but the extension
of benefits beyond the period during which the policy was in
force may be predicated upon the continuous total disability
of the insured, limited to the duration of the policy benefit
period, if any, or to payment of the maximum benefits.
Receipt of Medicare Part D benefits will not be considered in
determining a continuous loss.
(7)
If a Medicare supplement policy eliminates an outpatient
prescription drug benefit as a result of requirements
imposed by the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003, the modified policy shall
be deemed to satisfy the guaranteed renewal requirements of
this subsection.
B.
Minimum Benefit Standards.
(1)
Coverage of Part A Medicare eligible expenses for
hospitalization to the extent not covered by Medicare from
the 61st day through the 90th day in any Medicare benefit
period;
(2)
Coverage for either all or none of the Medicare Part A
inpatient hospital deductible amount;
(3)
Coverage of Part A Medicare eligible expenses incurred as
daily hospital charges during use of Medicare's lifetime
hospital inpatient reserve days;
(4)
Upon exhaustion of all Medicare hospital inpatient coverage
including the lifetime reserve days, coverage of ninety
10
percent (90%) of all Medicare Part A eligible expenses for
hospitalization not covered by Medicare subject to a lifetime
maximum benefit of an additional 365 days;
(5)
Coverage under Medicare Part A for the reasonable cost of
the first three (3) pints of blood (or equivalent quantities of
packed red blood cells, as defined under federal regulations)
unless replaced in accordance with federal regulations or
already paid for under Part B;
(6)
Coverage for the coinsurance amount or in case of hospital
outpatient department services paid under a prospective
payments system, the co-payment amount, of Medicare
eligible expenses under Part B regardless of hospital
confinement, subject to a maximum calendar year out-ofpocket amount equal to the Medicare Part B deductible
[$100];
(7)
Effective January 1, 1990, coverage under Medicare Part B for
the reasonable cost of the first three (3) pints of blood (or
equivalent quantities of packed red blood cells, as defined
under federal regulations), unless replaced in accordance
with federal regulations or already paid for under Part A,
subject to the Medicare deductible amount.