Illinois Administrative Code › Title 50 - INSURANCE › Part 2008 - MINIMUM STANDARDS FOR INDIVIDUAL AND GROUP MEDICARE SUPPLEMENT INSURANCE › Subpart B - COVERAGE, POLICY & BENEFIT PROVISIONS › Section 2008.70 - Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to February 11, 1992

Current through Register Vol. 48, No. 28, July 12, 2024
The following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  State prior to February 11, 1992. 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 following minimum standards.
				  These are minimum standards and do not preclude the inclusion of other
				  provisions or benefits that are not inconsistent with these standards.
a) General Standards
The following standards apply to Medicare supplement policies
				  and certificates and are in addition to all other requirements of this
				  Part.
1) A Medicare supplement policy
				or certificate shall not exclude or limit benefits for losses incurred more
				than 6 months after the effective date of coverage because the losses involved
				a preexisting condition. The policy or certificate shall not define a
				preexisting condition more restrictively than as a condition for which medical
				advice was given or treatment was recommended by or received from a physician
				within 6 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 such 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
				nonrenewed by the issuer solely on the grounds of deterioration of
				health.
5) An insurer
				shall:
A) Except as authorized by the
				Director, an issuer 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 subsection (a)(5)(D), the issuer
				shall offer certificateholders an individual Medicare supplement policy. The
				issuer shall offer the certificateholder 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
				that provides only such benefits as are required to meet the minimum standards
				as defined in Section
				2008.71(b).
C) If a membership in a group is
				terminated, the issuer shall:
i) offer the
				certificateholder such conversion opportunities as are described in subsection
				(a)(5)(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 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
				(a).