Section 376.864

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 26 Apr 1996, see footnote   

  376.864.  Policies not to duplicate benefits provided by Medicare — preexisting conditions, limitations on — director to issue rules establishing standards. — 1.  No Medicare supplement policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.

  2.  Notwithstanding any other provision of law to the contrary, a Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because it involved a preexisting condition.  The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

  3.  The director shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates.  Such standards shall be in addition to and in accordance with applicable laws of this state, including sections 376.770 to 376.800.  No requirement of the insurance laws relating to minimum required policy benefits, other than the minimum standards contained in sections 376.850 to 376.890, 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.

  4.  The director may adopt from time to time such reasonable regulations as are necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated thereunder, including but not limited to:

  (1)  Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;

  (2)  Establishing a uniform methodology for calculating and reporting loss ratios;

  (3)  Assuring public access to policies, premiums and loss ratio information of issuers of Medicare supplement insurance;

  (4)  Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;

  (5)  Establishing a policy for holding public hearings prior to approval of premium increases; and

  (6)  Establishing standards for Medicare select policies and certificates.

  5.  The director may adopt reasonable regulations that specify prohibited policy provisions not otherwise specifically authorized by statute which, in the opinion of the director, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.

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(L. 1989 H.B. 615 & 563, A.L. 1992 H.B. 1574, A.L. 1996 S.B. 883)

Effective 4-26-96