Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.459 - Minimum beneflt standards for 2020 standardized Medicare supplement benefit policies or certificates issued with an effective date of coverage on or after January 1, 2020

Current through May 31, 2024
(a) A Medicare
				  supplement policy or certificate issued with an effective date of coverage on
				  or after January 1, 2020 may not be advertised, solicited, or issued for
				  delivery in this state, unless it meets the requirements in this section and
				  all other applicable requirements of
				  3 AAC 28.410 -
				  3 AAC 28.510.
(b) A Medicare supplement policy or
				  certificate issued under this section may not exclude or limit coverage for a
				  loss due to a preexisting condition, if the loss was incurred more than six
				  months after the effective date of coverage. The policy or certificate 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 months before the effective date of coverage.
(c) A Medicare supplement policy or
				  certificate issued under this section may not indemnify against losses
				  resulting from sickness on a different basis than losses resulting from
				  accidents.
(d) A Medicare
				  supplement policy or certificate issued under this section may 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.
(e) A
				  Medicare supplement policy or certificate issued under this section may not
				  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.
(f) A Medicare supplement policy or
				  certificate issued under this section must be guaranteed renewable and
(1) the issuer may not cancel or nonrenew the
				  policy solely on the ground of health status of the individual;
(2) the insurer may not cancel or nonrenew
				  the policy for any reason other than nonpayment of premium or material
				  misrepresentation by the individual;
(3) if the Medicare supplement policy or
				  certificate is terminated by the group policyholder and is not replaced under
				  (5) of this subsection, the issuer shall offer each certificate holder an
				  individual Medicare supplement policy that, at the option of the certificate
				  holder provides for
(A) continuation of the
				  benefits contained in the group policy; or
(B) benefits that otherwise meet the
				  requirements of (a) - (/) of this section;
(4) if an individual is a certificate holder
				  in a group Medicare supplement policy and the individual terminates membership
				  in the group, the issuer shall
(A) offer the
				  certificate holder an opportunity to convert the group policy under (3) of this
				  subsection; or
(B) at the option of
				  the group policyholder, offer the certificate holder continuation of coverage
				  under the group policy; and
(5) 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
				  individuals covered under the old group policy on its date of termination;
				  coverage under the new group policy may not result in any exclusion for
				  preexisting conditions that would have been covered under the group policy that
				  is being replaced.