R590-146-6. Policy Provisions

(1) Except for a permitted preexisting condition clause, a policy or certificate may not be advertised, solicited, or issued for delivery as a Medicare supplement insurance policy if the policy or certificate contains a preexisting limitation or exclusion that is more restrictive than those of Medicare. (2) A policy or certificate may not use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions. (3) A policy or certificate may not contain benefits that duplicate benefits provided by Medicare. (4)(a) Subject to Subsections R590-146-7(1)(d), R590-146-7(1)(e), R590-146-7(1)(g), R590-146-8(1)(d), and R590-146-8(1)(e), a policy with benefits for outpatient prescription drugs in existence before January 1, 2006, shall be renewed for current policyholders who do not enroll in Medicare Part D at the option of the policyholder. (b) A policy with benefits for outpatient prescription drugs may not be issued after December 31, 2005. (c) After December 31, 2005, a policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless: (i) the policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Medicare Part D plan; and (ii) premiums are adjusted to reflect the elimination of outpatient prescription coverage as of Medicare Part D enrollment, accounting for any claims paid.