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 28.454 - Minimum benefit standards for 2010 standardized medicare supplement benefit policies or certificates issued with an effective date of coverage on or after 6/1/2010

Current through May 31, 2024
(a) A medicare supplement policy or
				  certificate issued with an effective date of coverage on or after June 1, 2010
				  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) - (
l
) 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 policy may
				  not result in any exclusion for preexisting conditions that would have been
				  covered under the group policy that is being replaced.