§ 27-18.2-3 - Standards for policy provisions.
SECTION 27-18.2-3
§ 27-18.2-3 Standards for policyprovisions. – (a) No Medicare supplement insurance policy or certificate in force in thestate shall contain benefits which duplicate benefits provided by Medicare.
(b) Notwithstanding any other provision of law of this state,a Medicare supplement policy or certificate shall not exclude or limit benefitsfor loss incurred more than six (6) months from the effective date of coveragebecause it involved a preexisting condition. The policy or certificate shallnot define a preexisting condition more restrictively than a condition forwhich medical advice was given or treatment was recommended by or received froma physician within six (6) months before the effective date of coverage.
(c) The director shall adopt reasonable regulations toestablish specific standards for policy provisions of Medicare supplementpolicies and certificates. Those standards shall be in addition to and inaccordance with the applicable laws of this state, including but not limited to§§ 27-18-3(a) and 42-62-12 and regulations promulgated pursuant tothose sections. No requirement of this title or chapter 62 of title 42 relatingto minimum required policy benefits, other than the minimum standards containedin this chapter, shall apply to Medicare supplement policies and certificates.The standards may cover, but not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions, and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definitions of terms.
(d) The director may adopt reasonable regulations thatspecify prohibited policy provisions not specifically authorized by statute,if, in the opinion of the director, those provisions are unjust, unfair, orunfairly discriminatory to any person insured or proposed to be insured under aMedicare supplement policy or certificate.
(e) The director shall adopt reasonable regulations toestablish minimum standards for benefits, claims payment, marketing practices,and compensation arrangements and reporting practices for Medicare supplementpolicies and certificates.
(f) The director may adopt any reasonable regulationsnecessary to conform Medicare supplement policies and certificates to therequirements of federal law and regulations promulgated pursuant to federallaw, including but not limited to:
(1) Requiring refunds or credits if the policies orcertificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating andreporting loss ratios;
(3) Assuring public access to policies, premiums, and lossratio information of issuers of Medicare supplement insurance;
(4) Establishing a process for approving or disapprovingpolicy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings priorto approval of premium increases which may include the applicant's provision ofnotice of the proposed premium increase to all subscribers subject to theproposed increase, at least ten (10) days prior to the hearing; and
(6) Establishing standards for Medicare select policies andcertificates.