Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-156 - MEDICARE SUPPLEMENT INSURANCE › Section 69O-156.006 - Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan, Policies or Certificates Issued for Delivery Prior to January 1, 1992

Current through Reg. 50, No. 138; July 16, 2024
As it relates to Pre-Standarized Medicare Supplement Benefit
				  Plan Policies or certificates issued for delivery prior to January 1, 1992, no
				  policy or certificate may be advertised, solicited, issued, delivered 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
				  which are not inconsistent with these standards.
(1) General Standards. The following
				standards apply to Medicare supplement policies and certificates and are in
				addition to all other requirements of this regulation.
(a) Medicare supplement coverage shall
				provide at least, but not be limited to, the benefits provided in Section
				627.674, F.S.
(b) A Medicare supplement policy or
				certificate shall not exclude or limit benefits for losses incurred more than
				six (6) months from the effective date of coverage because it involved a
				preexisting condition. 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
				(6) months before the effective date of coverage.
(c) A Medicare supplement policy or
				certificate shall not indemnify against losses resulting from sickness on a
				different basis than losses resulting from accidents.
(d) 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. The premium changes must be
				submitted to and approved by the Office pursuant to Sections
				627.410,
				627.411 and
				627.674, F.S.
(e) A "noncancellable," "guaranteed
				renewable," or "noncancellable and guaranteed renewable" Medicare supplement
				policy shall not:
1. 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
2. Be cancelled or
				nonrenewed by the issuer solely on the grounds of deterioration of
				health.
(f)
1. An issuer shall neither cancel nor
				nonrenew a Medicare supplement policy or certificate for any reason other than
				nonpayment of premium or material misrepresentation.
2.
a. If a
				group Medicare supplement insurance policy is terminated by the group
				policyholder and not replaced as provided in subparagraph
				69O-156.006(1)(f)
				4., F.A.C., 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 which provides only such benefits as are required to meet the
				minimum standards as defined in subsection
				69O-156.0075(2),
				F.A.C.
b. In either case,
				if the group policy was issued on an issue age basis, the individual Medicare
				supplement policy is issued at the original issue age of the terminated
				certificateholder, and is at the duration of the terminated certificate at the
				time of conversion.
3. If
				membership in a group is terminated, the issuer shall:
a. Offer the certificateholder such
				conversion opportunities as are described in subparagraph
				69O-156.006(1)(f)
				2., F.A.C.; or
b. At the option of
				the group policyholder, offer the certificateholder continuation of coverage
				under the group policy.
4.
a. If a
				group Medicare supplement policy is replaced by another group Medicare
				supplement policy purchased by the same policyholder, the succeeding issuer
				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.
b. If
				the terminated group policy was issued on an issue age basis and the policy
				reserves are transferred to the new insurer, the new group certificates shall
				retain the original issue ages of the insureds and shall commence at the same
				duration as the terminated certificates.
(g) 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 payment of the maximum benefits. Receipt of
				Medicare Part D benefits will not be considered in determining a continuous
				loss.
(h) If a Medicare supplement
				policy eliminates an outpatient 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.