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CHAPTER 20:06:13

MEDICARE SUPPLEMENT INSURANCE

Section

20:06:13:01        Repealed.

20:06:13:02        Definitions.

20:06:13:02.01   Requirements for definition of "accident" and similar words in policies.

20:06:13:02.02   Requirements for definitions in policies.

20:06:13:03        Applicability.

20:06:13:04        Repealed.

20:06:13:05        Repealed.

20:06:13:06        Repealed.

20:06:13:07        Repealed.

20:06:13:08        Repealed.

20:06:13:09        Repealed.

20:06:13:10        Repealed.

20:06:13:11        Repealed.

20:06:13:12        Repealed.

20:06:13:13        Repealed.

20:06:13:14        Eligible expenses under Medicare.

20:06:13:14.01   Repealed.

20:06:13:15        Repealed.

20:06:13:16        Waiver of coverage not allowed.

20:06:13:17        Applicability of benefit standards.

20:06:13:17.01   Repealed.

20:06:13:17.02   General standards for 1990 standardized Medicare supplement benefit plans.

20:06:13:17.03   Standards for basic core benefits for 1990 standardized Medicare supplement benefit plans.

20:06:13:17.04   Standards for additional benefits for 1990 standardized Medicare supplement benefit plans.

20:06:13:17.05   Requirements for standard Medicare supplement benefit plans.

20:06:13:17.06   Make-up of standardized benefit plans.

20:06:13:17.07   Suspension of coverage during period of eligibility for Medicaid.

20:06:13:17.08   Reinstitution of coverage following loss of eligibility for Medicaid.

20:06:13:17.09   Suspension requested by policyholder.

20:06:13:17.10   Prescription drug benefits under Medicare supplement plans.

20:06:13:17.11   General standards for standardized Medicare supplement benefit plan -- Issued for delivery after May 31, 2010.

20:06:13:17.12   Standards for basic core benefits common to Medicare supplement insurance benefit Plans A, B, C, D, F, F with High Deductible, G, M, and N.

20:06:13:17.13   Standards for additional benefits.

20:06:13:17.14   Requirements for standard Medicare supplement benefit plans -- Plans issued after May 31, 2010.

20:06:13:17.15   Make-up of standardized benefit plans -- Issued after May 31, 2010.

20:06:13:18        Premium adjustments to match Medicare benefit adjustments.

20:06:13:19        Renewability.

20:06:13:20        Extended benefits on termination of insurance.

20:06:13:21        Loss ratio standards.

20:06:13:21.01   Refund or credit calculation.

20:06:13:22        Annual filing of premium rates.

20:06:13:22.01   Filing of premium adjustments after Medicare benefit change.

20:06:13:22.02   Public hearings.

20:06:13:22.03   Filing and approval of policies and certificates and of premium rates required.

20:06:13:22.04   One policy or certificate form allowed -- Exceptions.

20:06:13:22.05   Discontinuance of availability.

20:06:13:22.06   Combination of experience for calculation of refund or credit.

20:06:13:22.07   New or innovative benefits -- Policy or certificate form allowed -- Exceptions -- issued after May 31, 2010.

20:06:13:23        Repealed.

20:06:13:24        Disclosure of preexisting conditions.

20:06:13:25        Increased benefits after issue.

20:06:13:26        Separate additional premium disclosure.

20:06:13:27        Buyer's guide.

20:06:13:28        Delivery of buyer's guide.

20:06:13:29        Use of term "Medicare supplement."

20:06:13:30        Disclosure requirements for policies or subscriber contracts that are not Medicare supplement policies.

20:06:13:31        Notice requirements for policies or certificates that are not Medicare supplement policies.

20:06:13:31.01   Disclosure requirements for Medicare supplement policies -- Riders and endorsements.

20:06:13:31.02   "Usual," "customary," and "reasonable" requirements prohibited.

20:06:13:31.03   Right of return.

20:06:13:32        Requirements concerning application forms and replacement coverage.

20:06:13:32.01   Transferred.

20:06:13:32.02   Disclosure by agent.

20:06:13:33        Repealed.

20:06:13:34        Replacement requirements for direct response insurers.

20:06:13:35        Notice of replacement.

20:06:13:36        Outline of coverage requirements.

20:06:13:37        Delivery of outline of coverage.

20:06:13:38        Revisions of outline of coverage.

20:06:13:39        Repealed.

20:06:13:40        Style and arrangement for outline of coverage.

20:06:13:41        Repealed.

20:06:13:42        Repealed.

20:06:13:43        Overinsurance.

20:06:13:43.01   Misrepresentation -- Unfair or deceptive trade practices.

20:06:13:43.02   Determination of suitability.

20:06:13:43.03   Medicare supplement and Medicare Part C (Medicare Advantage) or Medicare Cost duplication.

20:06:13:44        Failure to provide required forms.

20:06:13:45        Refund in replacement situations.

20:06:13:46        Coverage replaced within the same company.

20:06:13:47        Insurance replaced by the same agent.

20:06:13:48        Repealed.

20:06:13:49        Requirements for claims payment.

20:06:13:50        Policy classification -- Requirements and limitations.

20:06:13:51        Notice of benefit change.

20:06:13:52        Repealed.

20:06:13:53        Duplication of coverage prohibited.

20:06:13:54        Repealed.

20:06:13:55        Exception to reinstitution of coverage.

20:06:13:56        Continuation and conversion rights.

20:06:13:57        Standards for marketing.

20:06:13:58        Marketing practices prohibited.

20:06:13:58.01   Health insurance advertisement rate disclosures

20:06:13:58.02   Health insurance advertisement disclosure statements.

20:06:13:59        Reporting of multiple policies.

20:06:13:60        Cancellation or nonrenewal of policies.

20:06:13:60.01   Guaranteed renewable with benefit changes.

20:06:13:61        Agent compensation limited.

20:06:13:62        Repealed.

20:06:13:63        Medicare select policies and certificates.

20:06:13:64        Medicare select authorization.

20:06:13:65        Approval required for issuance.

20:06:13:66        Filing plan of operation.

20:06:13:67        Filing of changes.

20:06:13:68        Network restrictions.

20:06:13:69        Coverage for unavailable services.

20:06:13:70        Disclosure and outline of coverage requirements.

20:06:13:71        Applicant signature required.

20:06:13:72        Complaints and grievances.

20:06:13:73        Required offer of other Medicare supplement coverage.

20:06:13:74        Required offer of replacement coverage without a restricted network provision.

20:06:13:75        Continuation.

20:06:13:76        Compliance with data requests.

20:06:13:77        Creditable coverage.

20:06:13:78        Medicare Advantage plan.

20:06:13:79        Guaranteed issue.

20:06:13:80        Guaranteed issue -- Eligible persons.

20:06:13:80.01   Guaranteed issue time periods.

20:06:13:80.02   Extended medigap access for interrupted trial periods.

20:06:13:81        Guaranteed issue -- Products to which eligible persons are entitled.

20:06:13:82        Guaranteed issue -- Notification provisions.

20:06:13:83        Open enrollment.

20:06:13:84        Open enrollment required for Medicare eligible individuals regardless of age.

20:06:13:85        Notice requirements.

20:06:13:86        Exchanging of standardized plan.

20:06:13:86.01   Exchanging of standardized plan -- Age rate schedule.

20:06:13:86.02   Exchanging of standardized plan -- Rating class.

20:06:13:86.03   Exchanging of standardized plan -- Preexisting conditions and incontestability period.

20:06:13:86.04   Exchanging of standardized plan -- Offering.

20:06:13:87        Applicability of genetic information.

20:06:13:88        Definitions applicable to genetic information.

20:06:13:89        Use of genetic information.

20:06:13:90        Request of genetic testing.

20:06:13:91        Requirement of genetic testing.

20:06:13:92        Genetic information -- Underwriting purposes and enrollment.

Appendix A  Medicare Supplement Refund Calculation Forms.

Appendix B  Form for Reporting Medicare Supplement Policies.

Appendix C  Notice to Applicant Regarding Replacement of Medicare Supplement Insurance.

Appendix D  Outline of Medicare Supplement Coverage Policies Plans A through N.

Appendix E  Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare.


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