Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-8 - MEDICARE SUPPLEMENT INSURANCE › Rule 120-2-8-.07 - Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to the Effective Date of This Regulation

Current through Rules and Regulations filed through June 27, 2024
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.
(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) 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 shall 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.
(b) A Medicare supplement policy or
				certificate shall not indemnify against losses resulting from sickness on a
				different basis than losses resulting from accidents.
(c) 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 through filings as otherwise provided within this Regulation
				Chapter to correspond with such changes.
(d) 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.
(e)
1. Except as authorized by the Commissioner
				of Insurance of this State, 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. If a group Medicare supplement insurance
				policy is terminated by the group policyholder and not replaced as provided in
				Paragraph (e)4., 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
				120-2-8-.08(5)(b)
				of this regulation.
3.
				If membership in a group is terminated, the issuer shall:
(i) Offer the certificateholder the
				conversion opportunities described in Subparagraph (ii); or
(ii) At the option of the group policyholder,
				offer the certificateholder continuation of coverage under the group
				policy.
4. 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.
(f) Termination of a Medicare supplement
				policy or certificate shall be without prejudice to any continuous loss that
				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.
(g) 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.