Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 12 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 16-12-5.4 - Minimum benefit standards for pre-standardized Medicare supplement benefit plan policies or certificates issued for delivery prior to September 3, 1992

Current through June, 2024
(a) No policy or certificate may be
			 advertised, solicited, or issued for delivery in this State as a Medicare
			 supplement policy or certificate unless it meets or exceeds the minimum
			 standards set forth in this section. These are minimum standards and do not
			 preclude the inclusion of other provisions or benefits which are not
			 inconsistent with these standards.
(b) General standards. The following
			 standards apply to Medicare supplement policies and certificates and are in
			 addition to all other requirements of this chapter:
(1) 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;
(2) A Medicare supplement policy or
			 certificate shall not indemnify against losses resulting from sickness on a
			 different basis than losses resulting from accidents;
(3) A Medicare supplement policy or
			 certificate shall provide that benefits designed to cover cost sharing amounts
			 under Medicare will be changed automatically to coincide with any changes in
			 the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums
			 may be modified to correspond with the changes;
(4) A "noncancellable," "guaranteed
			 renewable," or "noncancellable and guaranteed renewable" Medicare supplement
			 policy shall not:
(A) Provide for termination
			 of coverage of a spouse solely because of the occurrence of an event specified
			 for termination of coverage of the insured, other than the nonpayment of
			 premium; or
(B) Be cancelled or
			 non-renewed by the issuer solely on the grounds of deterioration of
			 health;
(5)
(A) Except as authorized by the commissioner
			 of this State, an issuer shall neither cancel nor non-renew a Medicare
			 supplement policy or certificate for any reason other than nonpayment of
			 premium or material misrepresentation;
(B) If a group Medicare supplement insurance
			 policy is terminated by the group policyholder and not replaced as provided in
			 subparagraph (D), the issuer shall offer each certificate holder an individual
			 Medicare supplement policy. The issuer shall offer the certificate holder at
			 least the following choices:
(i) An individual
			 Medicare supplement policy currently offered by the issuer having comparable
			 benefits to those contained in the terminated group Medicare supplement policy;
			 and
(ii) An individual Medicare
			 supplement policy which provides only those benefits as are required to meet
			 the minimum standards as defined in subsection
			 16-12-5.6(c)
			 of this chapter;
(C) If
			 membership in a group is terminated, the issuer shall:
(i) Offer the certificate holder the
			 conversion opportunities as are 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.