Connecticut Administrative Code › Title 38a - Insurance Department › 495 - Medicare Supplement Insurance Minimum Standards › Section 38a-495-5 - Minimum benefit standards

Current through July 10, 2024
(a) No insurance
			 policy or subscriber contract which provides benefits to any resident of this
			 State may be advertised, solicited or issued for delivery in this State who is
			 eligible for Medicare which does not meet the following minimum standards.
			 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 are in addition to all other requirements of Sections
			 38a-495-1
			 to
			 38a-495-17,
			 inclusive.
(1) A Medicare supplement policy
			 may not deny a claim for losses incurred more than six (6) months from the
			 effective date of coverage for a preexisting condition. The policy may 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 (6) months before the effective date of
			 coverage.
(2) A Medicare supplement
			 policy may not indemnify against losses resulting from sickness on a different
			 basis than losses resulting from accidents.
(3) A Medicare supplement policy 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 amount and copayment percentage factors. Premiums may be
			 modified to correspond with such changes only with the prior approval of the
			 Commissioner.
(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 nonrenewed by the insurer
			 solely on the grounds of deterioration of health.
(5)
(A)
			 Except as authorized by the Commissioner, an insurer shall neither cancel nor
			 nonrenew 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
			 paragraph (D) of this subdivision, the insurer shall offer certificateholders
			 an individual Medicare supplement policy. The insurer shall offer the
			 certificateholder at least the following choices:
(i) an individual Medicare supplement policy
			 which provides for continuation of the benefits contained in the group policy;
			 and
(ii) an individual Medicare
			 supplement policy which provides only such benefits as are required to meet the
			 minimum standards.
(C)
			 If membership in a group is terminated, the insurer shall:
(i) offer the certificateholder such
			 conversion opportunities as are described in paragraph (B); or
(ii) at the option of the group policyholder,
			 offer the certificateholder 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 succeeding insurer 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 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 payment of the maximum benefits.