reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.08 - Required Disclosure Provisions

Current through June 25, 2024
A. Renewability.
				Individual long-term care insurance policies shall contain a renewability
				provision. Such provision shall be appropriately captioned, shall appear on the
				first page of the policy, and shall clearly state the duration, where limited,
				of renewability and the duration of the term of coverage for which the policy
				is issued and for which it may be renewed. This provision shall not apply to
				policies which do not contain a renewability provision, and under which the
				right to non-renew is reserved solely to the policyholder.
B. Riders and Endorsements. Except for riders
				or endorsements by which the insurer effectuates a request made in writing by
				the insured under an individual long-term care insurance policy, all riders or
				endorsements added to an individual long-term care insurance policy after date
				of issue or at reinstatement or renewal which reduce or eliminate benefits or
				coverage in the policy shall require signed acceptance by the individual
				insured. After the date of policy issue, any rider or endorsement which
				increases benefits or coverage with a concomitant increase in premium during
				the policy term must be agreed to in writing signed by the insured, except if
				the increased benefits or coverage are required by law. Where a separate
				additional premium is charge for benefits provided in connection with riders or
				endorsements, such premium charge shall be set forth in the policy, rider or
				endorsement.
C. Payment of
				benefits: A long-term care insurance policy which provides for the payment of
				benefits based on standards described as "usual and customary," "reasonable and
				customary" or words of similar import shall include a definition of such terms
				and an explanation of such terms in its accompanying outline of
				coverage.
D. Limitations. If a
				long-term care insurance policy or certificate contains anylimitations with
				respect to preexisting conditions, such limitations shall appear asa separate
				paragraph of the policy or certificate and shall be labeled as "Preexisting
				Condition Limitations."
E. Other
				Limitations or Conditions on Eligibility for Benefits. A long-term care
				insurance policy or certificate containing any limitations or conditions for
				eligibility other than those prohibited in Section 6C(2) of the Regulation
				shall set forth a description of such limitations or conditions, including any
				required number of days of confinement, in a separate paragraph of the policy
				or certificate and shall label such paragraph "Limitations or Conditions on
				Eligibility for Benefits."
Miss Code Ann §
										83-5-1
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.09 - Prohibition against Post-Claims Underwriting

Current through June 25, 2024
A. All
				applications for long-term care insurance policies or certificates except those
				which are guaranteed issue shall contain clear and unambiguous questions
				designed to ascertain the health condition of the applicant.
B.
1. If an
				application for long-term care insurance contains a question which asks whether
				the applicant has had medication prescribed by a physician, it must also ask
				the applicant to list the medication that has been prescribed.
2. If the medications listed in such
				application were known by the insurer, or should have been known at the time of
				application, to be directly related to a medical condition for which coverage
				would otherwise be denied, then the policy or certificate shall not be
				rescinded for that condition.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.10 - Minimum Standards for Home Health Care Benefits in Long-Term Care Insurance Policies

Current through June 25, 2024
A. A long-term care
				insurance policy or certificate may not, if it provides benefits for home
				health care services, limit or exclude benefits:
1. By requiring that the insured/claimant
				would need skilled care in a skilled nursing facility if home health care
				services not provided;
2. By
				requiring that the insured/claimant first or simultaneously receive nursing
				and/or therapeutic services in a home or community setting before home health
				care services are covered;
3. By
				limiting eligible services to services provided by registered nurses or
				licensed practical nurses;
4. By
				requiring that a nurse or therapist provide services covered by the policy that
				can be provided by a home health aide, or other licensed or certified home care
				worker acting within the scope of his or her licensure or
				certification;
5. By requiring that
				the insured/claimant have an acute condition before home health care services
				are covered;
6. By limiting
				benefits to services provided by Medicare-certified agencies or
				providers.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.11 - Requirement to Offer Inflation Protection

Current through June 25, 2024
A. No insurer may
				offer a long-term care insurance policy unless the insurer also offers to the
				policyholder the option to purchase a policy that provides for benefit levels
				to increase with benefit maximums or reasonable durations which are meaningful
				to account for reasonably anticipated increases in the cost of long-term care
				services covered by the policy. Insurers must offer to each policyholder, at
				the time of purchase, the option to purchase a policy with an inflation
				protection feature no less favorable than one of the following:
1. Increases benefit levels annually, (in a
				manner so that the increases are compounded annually);
2. Guarantees the insured individual the
				right to periodically increase benefit levels without providing evidence of
				insurability or health status so long as the option for the previous period has
				not been declined; or
3. Covers a
				specified percentage of actual or reasonable charges.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.13 - Discretionary Powers of Commissioner

Current through June 25, 2024
The Commissioner may upon written request and after an
				  administrative hearing, issue an order to modify or suspend a specific
				  provision or provisions of this regulation with respect to a specific long-term
				  care insurance policy or certificate upon a written finding that:
A. The modification or suspension would be in
				the best interest of the insureds; and
B. The purposes to be achieved could not be
				effectively or efficiently achieved without the modification or suspension;
				and
C.
1. The modification or suspension is
				necessary to the development of an innovative and reasonable approach for
				insuring long-term care; or
2. The
				policy or certificate is to be issued to residents of a life care or continuing
				care retirement community or some other residential community for the elderly
				and the modification or suspension is reasonably related to the special needs
				or nature of such a community; or
3. The modification or suspension is
				necessary to permit long-term care insurance to be sold as part of, or in
				conjunction with, another insurance project.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.14 - Reserve Standards

Current through June 25, 2024
A. When long-term
				care benefits are provided through the acceleration of benefits under group or
				individual life policies or riders to such policies, policy reserves for such
				benefits shall be determined in accordance with Miss Code Ann. Section
				83-7-23(1972),
				as Amended. Claim reserves must also be established in the case when such
				policy or rider is in claim status.
B. Reserves for policies and riders subject
				to this subsection should be based on the multiple decrement model utilizing
				all relevant decrements except for voluntary termination rates. Single
				decrement approximations are acceptable if the calculation produces essentially
				similar reserves, if the reserve is clearly more conservative, or if the
				reserve is immaterial. The calculations may take into account the reduction in
				life insurance benefits due to the payment of long-term care benefits. However,
				in no event shall the reserves for the long-term care benefit and the life
				insurance benefit be less than the reserves for the life insurance benefit
				assuming no long-term care benefit.
In the development and calculation of reserves for policies
				  and riders subject to this subsection, due regard shall be given to the
				  applicable policy provisions, marketing methods, administrative procedures and
				  all other considerations which have an impact on projected claim costs,
				  including, but not limited to, the following:
1. Definition of insured events;
2. Covered long-term care
				facilities;
3. Existence of home
				convalescence-care coverage;
4.
				Definition of facilities;
5.
				Existence or absence of barriers to eligibility;
6. Premium waiver provision;
7. Renewability;
8. Ability to raise premiums;
9. Marketing methods;
10. Underwriting procedures;
11. Claims adjustment procedures;
12. Waiting period;
13. Maximum benefit;
14. Availability of eligible
				facilities;
15. Margin in claim
				cost;
16. Optional nature of
				benefit;
17. Delay in eligibility
				for benefit;
18. Inflation
				protection provisions; and
19.
				Guaranteed insurability option.
Any applicable valuation morbidity table shall be certified
				  as appropriate as a statutory valuation table by a member of the American
				  Academy of Actuaries.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.15 - Loss Ratio

Current through June 25, 2024
Benefits under individual long-term care insurance policies
				  shall be deemed reasonable in relation to premiums provided the expected loss
				  ratio is at least sixty percent, calculated in a manner which provides for
				  adequate reserving of the long-term care insurance risk. In evaluating the
				  expected loss ratio, due consideration shall be given to all relevant factors,
				  including:
A. Statistical credibility
				of incurred claims experience and earned premiums;
B. The period for which rates are computed to
				provide coverage;
C. Experienced
				and projected trends;
D.
				Concentration of experience within early policy duration;
E. Expected claim fluctuation;
F. Experience refunds, adjustments or
				dividends;
G. Renewability
				features;
H. All appropriate
				expense factors;
I.
				Interest;
J. Experimental nature of
				coverage;
K. Policy
				reserves;
L. Mix of business by
				risk classification; and
M. Product
				features such as long elimination periods, high deductibles and high maximum
				limits.
Miss Code Ann
				  §§
										83-5-1;
				  83-5-29 (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.16 - Filing Requirement

Current through June 25, 2024
Prior to an insurer or similar organization offering group
				  long-term care insurance to a resident of this state, it shall file with the
				  Commissioner evidence that the group policy or certificate thereunder has been
				  approved by a state having statutory or regulatory long-term care insurance
				  requirements substantially similar to those adopted in this
				  state.
Miss Code Ann
				  §§
										83-5-1;
				  83-9-5(7) (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.18 - Requirement to Deliver Shopper's Guide

Current through June 25, 2024
A. A long-term care
				insurance shopper's guide in the format developed by the National Association
				of Insurance Commissioners, or a guide developed or approved by the
				Commissioner, shall be provided to all prospective applicants of a long-term
				care insurance policy or certificate.
1. In
				the case of agent solicitations, an agent must deliver the shopper's guide
				prior to the presentation of an application or enrollment form.
2. In the case of direct response
				solicitations, the shopper's guide must be presented in conjunction with any
				application or enrollment form.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.19 - Effective Date

Current through June 25, 2024
Thi
s
regulation shall become effective thirty
				  (30) days after its adoption and filing with the Mississippi Secretary of
				  State's Office, as required by law.
Miss code Ann §
										25-43-3.113
				  (Rev. 2010)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Rule 19-3-9.01 - Authority

Current through June 25, 2024
This Regulation is promulgated by the Commissioner of
				  Insurance pursuant to the authority granted to him by
Miss. Code
				  Ann
. §
									83-5-1
				  and
				  83-9-211(1972),
				  in order to implement the provisions of the Comprehensive Health Insurance Risk
				  Pool Association Act and is promulgated in accordance with Mississippi
				  Insurance Department Regulation No. 88-101, said regulation being the Rules of
				  Practice and Procedure before the Mississippi Insurance
				  Department.
Miss Code Ann
				  §§
										83-5-1;
				  83-9-211 (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Rule 19-3-9.02 - Purpose

Current through June 25, 2024
The purpose of this Regulation is to implement the intent of
				  the Mississippi Legislature with respect to making the existence of the
				  insurance plan offered by the Comprehensive Health Insurance Risk Pool
				  Association known to those citizens of the State of Mississippi who, because of
				  health conditions, cannot secure health insurance coverage by requiring
				  insurers to notify persons that are rejected for health insurance coverage
				  because of health conditions that such persons may be eligible for the
				  insurance plan offered by the Comprehensive Health Insurance Risk Pool
				  Association and to establish a standardized form for such
				  notice.
Miss Code Ann §
										83-9-203 (Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Rule 19-3-9.03 - Definitions

Current through June 25, 2024
A. "Health insurance" shall have the same
				meaning as defined in
Miss. Code Ann
.§
									83-9-205(1972).
B. "Insurer" shall have the same meaning as
				defined in
Miss. Code Ann
.§ 83-
				9-205(1972).
Miss Code Ann §
										83-9-205
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Rule 19-3-9.04 - Application

Current through June 25, 2024
Any insurer that rejects a person's application for health
				  insurance coverage substantially similar to the coverage offered by the
				  Comprehensive Health Insurance Risk Pool Association because of health
				  conditions of such person shall give such person written notice that he or she
				  may be eligible for coverage under the Comprehensive Health Insurance Risk Pool
				  Association plan and furnish the name, address and toll free telephone number
				  of the Comprehensive Health Insurance Risk Pool Association.
Such notice shall be in the form attached hereto as appendix
				  A, which is hereby made a part of this Regulation. Insurers may print the
				  notice form on their own stationary but shall use the order, format and content
				  of the notice form, as prescribed by the Commissioner of Insurance. The insurer
				  shall attach a copy of the notice form to the notice of rejection for insurance
				  coverage.
Miss Code Ann §
										83-9-215
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Rule 19-3-9.05 - Severability

Current through June 25, 2024
If any provision of any section of this Regulation or the
				  application thereof to any circumstance or person or entity is held invalid,
				  such invalidity shall not affect any other provision of that section or
				  application of the Regulation which can be given effect without the invalid
				  provision or application, and to this end the provisions of this Regulation are
				  declared to be severable.
Miss Code Ann
				  §§
										83-5-1;
				  83-9-215 (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Rule 19-3-9.06 - Effective Date

Current through June 25, 2024
This Regulation shall become effective immediately upon
				  filing with the Office of the Secretary of State.
Miss Code Ann §
										25-43-3.113
				  (Rev. 2010)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 9 - (94-101) Requiring Notification of Coverage Offered by Comprehensive Health Insurance Risk Pool Association Upon Rejection of Application for Coverage › Appendix 19-3-9-A - Comprehensive Health Insurance Risk Pool Association Notice Form

Current through June 25, 2024
Date
Name
Address
City, State Zip Code
RE: Applicant/Insured's Name
Policy # (if applicable)
Dear __________________ :
We believe that you may qualify for health insurance from the
				  Mississippi Comprehensive Health Insurance Risk Pool Association (the
				  "Association"). This insurance is available to Mississippi residents who,
				  because of health conditions, cannot secure health insurance coverage
				  substantially similar to the Association plan coverage without material
				  underwriting restrictions at a rate equal to or less than the Association plan
				  rate. Other eligibility requirements, exclusions and limitations may
				  apply.
You may apply to the Association for a determination of your
				  eligibility for insurance on application forms available from the
				  Association.
For more information regarding the Association go to
www.mississippihealthpool.org
or contact the Association at:
Mississippi Comprehensive Health Insurance Risk Pool
				  Association
Post Office Box 13748
Jackson, MS 39236-3748
888-820-9400
Insurance Company Name Address
Contact Person Phone Number
Miss Code Ann §
										83-9-215
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.01 - Purpose

Current through June 25, 2024
The purpose of this regulation is to provide for the
				  reasonable standardization of coverage and simplification of terms and benefits
				  of Medicare supplement policies; to facilitate public understanding and
				  comparison of such policies; to eliminate provisions contained in such policies
				  which may be misleading or confusing in connection with the purchase of such
				  policies or with the settlement of claims; and to provide for full disclosures
				  in the sale of accident and sickness insurance coverages to persons eligible
				  for Medicare.
Miss Code Ann §
										83-9-103
				  (Rev. 2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.02 - Authority

Current through June 25, 2024
This regulation is issued pursuant to the authority vested
				  in the commissioner under Miss. Code Ann. §
									83-9-103
				  and §
									83-9-105.
Miss Code Ann
				  §§
										83-9-103;
				  83-9-105 (Rev. 2011)
Wherever the term "commissioner" appears, the title of the
					 chief insurance regulatory official of the state should be
					 inserted.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.03 - Applicability and Scope

Current through June 25, 2024
A. Except as
				otherwise specifically provided in Rules
				10.07,
				10.13,
				10.14,
				10.17 and
				10.22, this regulation shall apply
				to:
1. All Medicare supplement policies
				delivered or issued for delivery in this state on or after the effective date
				of this regulation; and
2. All
				certificates issued under group Medicare supplement policies, which
				certificates have been delivered or issued for delivery in this state.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.04 - Definitions

Current through June 25, 2024
For purposes of this regulation:
A. "Applicant" means:
1. In the case of an individual Medicare
				supplement policy, the person who seeks to contract for insurance benefits, and
2. In the case of a group Medicare
				supplement policy, the proposed certificate holder.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.05 - Policy Definitions and Terms

Current through June 25, 2024
No policy or certificate may be advertised, solicited or
				  issued for delivery in this state as a Medicare supplement policy or
				  certificate unless the policy or certificate contains definitions or terms
				  which conform to the requirements of this section.
A. "Accident," "accidental injury," or
				"accidental means" shall be defined to employ "result" language and shall not
				include words that establish an accidental means test or use words such as
				"external, violent, visible wounds" or similar words of description or
				characterization.
1. The definition shall not
				be more restrictive than the following: "Injury or injuries for which benefits
				are provided means accidental bodily injury sustained by the insured person
				which is the direct result of an accident, independent of disease or bodily
				infirmity or any other cause, and occurs while insurance coverage is in force."
2. The definition may provide that
				injuries shall not include injuries for which benefits are provided or
				available under any workers' compensation, employer's liability or similar law,
				or motor vehicle no-fault plan, unless prohibited by law.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.06 - Policy Provisions

Current through June 25, 2024
A. Except for
				permitted preexisting condition clauses as described in Rules
				10.07 A(1), 10.08A(1), and
				10.08.1A(1) of this regulation, no policy or certificate may be advertised,
				solicited or issued for delivery in this state as a Medicare supplement policy
				if the policy or certificate contains limitations or exclusions on coverage
				that are more restrictive than those of Medicare.
B. No Medicare supplement policy or
				certificate may use waivers to exclude, limit or reduce coverage or benefits
				for specifically named or described preexisting diseases or physical
				conditions.
C. No Medicare
				supplement policy or certificate in force in the state shall contain benefits
				that duplicate benefits provided by Medicare.
D.
1.
				Subject to Rules
				10.07 A(4), (5) and (7), and
				10.08A(4) and (5) of this regulation, a Medicare supplement policy with
				benefits for outpatient prescription drugs in existence prior to January 1,
				2006 shall be renewed for current policyholders who do not enroll in Part D at
				the option of the policyholder.
2.
				A Medicare supplement policy with benefits for outpatient prescription drugs
				shall not be issued after December 31, 2005.
3. After December 31, 2005, a Medicare
				supplement policy with benefits for outpatient prescription drugs may not be
				renewed after the policyholder enrolls in Medicare Part D unless:
a. The policy is modified to eliminate
				outpatient prescription coverage for expenses of outpatient prescription drugs
				incurred after the effective date of the individual's coverage under a Part D
				plan and;
b. Premiums are adjusted
				to reflect the elimination of outpatient prescription drug coverage at the time
				of Medicare Part D enrollment, accounting for any claims paid, if applicable.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.09.1

Current through June 25, 2024
Standard Medicare Supplement Benefit Plans for 2010
				  Standardized Supplement Benefit Plan Policies or Certificates Issued for
				  Delivery Effective Date for Coverage on or After June 10, 2010
The following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  state with an effective date for coverage on or after June 1, 2010. No policy
				  or certificate may be advertised, solicited, delivered or issued for delivery
				  in this state as a Medicare supplement policy or certificate unless it complies
				  with these benefit plan standards. Benefit plan standards applicable to
				  Medicare supplement policies and certificates with an effective date for
				  coverage before June 1, 2010 remain subject to the requirements of Miss. Code
				  Ann. §
									83-9-101
				  to 115, and this regulation.
A.
1. An issuer shall make available to each
				prospective policyholder and certificate holder a policy form or certificate
				form containing only the basic (core) benefits, as defined in Rule 10.08.1 B of
				this regulation.
2. If an issuer
				makes available any of the additional benefits described in Rule 10.08.1 C, or
				offers standardized benefit Plans K or L (as described in Rules 10.09.1 E(8)
				and (9) of this regulation), then the issuer shall make available to each
				prospective policyholder and certificate holder, in addition to a policy form
				or certificate form with only the basic (core) benefits as described in
				subsection A(1) above, a policy form or certificate form containing either
				standardized benefit Plan C (as described in Rule 10.09.1 E(3) of this
				regulation) or standardized benefit Plan F (as described in Rule 10.09.1 E(5)
				of this regulation).
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.09.2

Current through June 25, 2024
Standard Medicare Supplement Benefit Plans for 2020
				  Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued
				  for Delivery to Individuals Newly Eligible for Medicare on or After January 1,
				  2020.
The Medicare Access and CHIP Reauthorization Act of 2015
				  (MACRA) requires the following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  state to individuals newly eligible for Medicare on or after January 1, 2020.
				  No policy or certificate that provides coverage of the Medicare Part B
				  deductible may be advertised, solicited, delivered or issued for delivery in
				  this state as a Medicare supplement policy or certificate to individuals newly
				  eligible for Medicare on or after January 1, 2020. All policies must comply
				  with the following benefit standards. Benefit plan standards applicable to
				  Medicare supplement policies and certificates issued to individuals eligible
				  for Medicare before January 1, 2020, remain subject to the requirements of
				  Miss. Code Ann. §
									83-9-101
				  to 115, and this regulation.
A.
				Benefit Requirements.The standards and requirements of Rule
				10.09.1 shall apply to all Medicare
				supplement policies or certificates deliveredor issued for delivery to
				individuals newly eligible for Medicare on or after January 1, 2020, with the
				following exceptions:
1. Standardized
				Medicare supplement benefit Plan C is redesignated as Plan D and shall provide
				the benefits contained in Rule
				10.09.1 E(3) of this regulation but
				shall not provide coverage for one hundred percent (100¢) or any portion
				of the Medicare Part B deductible.
2. Standardized Medicare supplement benefit
				Plan F is redesignated as Plan G and shall provide the benefits contained in
				Rule
				10.09.1 E(5) of this regulation but
				shall not provide coverage for one hundred percent (100¢) or any portion
				of the Medicare Part B deductible.
3. Standardized Medicare supplement benefit
				plans C, F, and F with High Deductible may not be offered to individuals newly
				eligible for Medicare on or after January 1, 2020.
4. Standardized Medicare supplement benefit
				Plan F With High Deductible is redesignated as Plan G With High Deductible and
				shall provide the benefits contained in Rule
				10.09.1 E(6)of this regulation but
				shall not provide coverage for one hundred percent (100¢) or any portion
				of the Medicare Part B deductible; provided further that, the Medicare Part B
				deductible paid by the beneficiary shall be considered an out-of-pocket expense
				in meeting the annual high deductible.
5. The reference to Plans C or F contained in
				Rule
				10.09.1 A(2) is deemed a reference
				to Plans D or G for purposes of this section.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.10 - Medicare Select Policies and Certificates

Current through June 25, 2024
A.
1. This section shall apply to Medicare
				Select policies and certificates, as defined in this section.
2. No policy or certificate may be advertised
				as a Medicare Select policy or certificate unless it meets the requirements of
				this section.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.11 - Open Enrollment

Current through June 25, 2024
A. An issuer shall
				not deny or condition the issuance or effectiveness of any Medicare supplement
				policy or certificate available for sale in this state, nor discriminate in the
				pricing of a policy or certificate because of the health status, claims
				experience, receipt of health care, or medical condition of an applicant in the
				case of an application for a policy or certificate that is submitted prior to
				or during the six (6) month period beginning with the latter of the first day:
				of the first month in which an individual is both sixty-five years of age or
				older and is enrolled for benefits under Medicare Part B Each Medicare
				supplement policy and certificate currently available from an insurer shall be
				made available to all applicants who qualify under this subsection without
				regard to age.
B.
1. If an applicant qualifies under Subsection
				A and submits an application during the time period referenced in Subsection A
				and, as of the date of application, has had a continuous period of creditable
				coverage of at least six (6) months, the issuer shall not exclude benefits
				based on a preexisting condition.
2.
				If the applicant qualifies under Subsection A and submits an application during
				the time period referenced in Subsection A and, as of the date of application,
				has had a continuous period of creditable coverage that is less than six (6)
				months, the issuer shall reduce the period of any preexisting condition
				exclusion by the aggregate of the period of creditable coverage applicable to
				the applicant as of the enrollment date. The Secretary shall specify the manner
				of the reduction under this subsection.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.12 - Guaranteed Issue for Eligible Persons

Current through June 25, 2024
A. Guaranteed
				Issue.
1. Eligible persons are those
				individuals described in Subsection B who seek to enroll under the policy
				during the period specified in Subsection C, and who submit evidence of the
				date of termination, disenrollment, or Medicare Part D enrollment with the
				application for a Medicare supplement policy.
2. With respect to eligible persons, an
				issuer shall not deny or condition the issuance or effectiveness of a Medicare
				supplement policy described in Subsection E that is offered and is available
				for issuance to new enrollees by the issuer, shall not discriminate in the
				pricing of such a Medicare supplement policy because of health status, claims
				experience, receipt of health care, or medical condition, and shall not impose
				an exclusion of benefits based on a preexisting condition under such a Medicare
				supplement policy.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.13 - Standards for Claims Payment

Current through June 25, 2024
A. An issuer shall
				comply with Section 1882(c)(3) of the Social Security Act (as enacted by
				section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA)
				1987, Pub. L. No. 100-203 ) by:
1. Accepting a
				notice from a Medicare carrier on dually assigned claims submitted by
				participating physicians and suppliers as a claim for benefits in place of any
				other claim form otherwise required and making a payment determination on the
				basis of the information contained in that notice;
2. Notifying the participating physician or
				supplier and the beneficiary of the payment determination;
3. Paying the participating physician or
				supplier directly;
4. Furnishing,
				at the time of enrollment, each enrollee with a card listing the policy name,
				number and a central mailing address to which notices from a Medicare carrier
				may be sent;
5. Paying user fees
				for claim notices that are transmitted electronically or otherwise; and
6. Providing to the Secretary of
				Health and Human Services, at least annually, a central mailing address to
				which all claims may be sent by Medicare carriers.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.14 - Loss Ratio Standards and Refund or Credit Of Premium

Current through June 25, 2024
A. Loss Ratio Standards.
1.
a. A
				Medicare Supplement policy form or certificate form shall not be delivered or
				issued for delivery unless the policy form or certificate form can be expected,
				as estimated for the entire period for which rates are computed to provide
				coverage, to return to policyholders and certificate holders in the form of
				aggregate benefits (not including anticipated refunds or credits) provided
				under the policy form or certificate form:
i.
				At least seventy-five percent (75¢) of the aggregate amount of premiums
				earned in the case of group policies; or
ii. At least sixty-five percent (65¢) of
				the aggregate amount of premiums earned in the case of individual policies;
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.15 - Filing and Approval of Policies and Certificates and Premium Rates

Current through June 25, 2024
A. An issuer shall not deliver or issue for
				delivery a policy or certificate to a resident of this state unless the policy
				form or certificate form has been filed with and approved by the commissioner
				in accordance with filing requirements and procedures prescribed by the
				commissioner.
B. An issuer shall
				file any riders or amendments to policy or certificate forms to delete
				outpatient prescription drug benefits as required by the Medicare Prescription
				Drug, Improvement, and Modernization Act of 2003 only with the commissioner in
				the state in which the policy or certificate was issued.
C. An issuer shall not use or change premium
				rates for a Medicare supplement policy or certificate unless the rates, rating
				schedule and supporting documentation have been filed with and approved by the
				commissioner in accordance with the filing requirements and procedures
				prescribed by the commissioner.
D.
1. Except as provided in Paragraph (2) of
				this subsection, an issuer shall not file for approval more than one form of a
				policy or certificate of each type for each standard Medicare supplement
				benefit plan.
2. An issuer may
				offer, with the approval of the commissioner, up to four (4) additional policy
				forms or certificate forms of the same type for the same standard Medicare
				supplement benefit plan, one for each of the following cases:
a. The inclusion of new or innovative
				benefits;
b. The addition of either
				direct response or agent marketing methods;
c. The addition of either guaranteed issue or
				underwritten coverage;
d. The
				offering of coverage to individuals eligible for Medicare by reason of
				disability.
3. For the
				purposes of this section, a "type" means an individual policy, a group policy,
				an individual Medicare Select policy, or a group Medicare Select policy.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.16 - Permitted Compensation Arrangements

Current through June 25, 2024
A. An issuer or
				other entity may provide commission or other compensation to an agent or other
				representative for the sale of a Medicare supplement policy or certificate only
				if the first year commission or other first year compensation is no more than
				200 percent of the commission or other compensation paid for selling or
				servicing the policy or certificate in the second year or period.
B. The commission or other compensation
				provided in subsequent (renewal) years must be the same as that provided in the
				second year or period and must be provided for no fewer than five (5) renewal
				years.
C. No issuer or other entity
				shall provide compensation to its agents or other producers and no agent or
				producer shall receive compensation greater than the renewal compensation
				payable by the replacing issuer on renewal policies or certificates if an
				existing policy or certificate is replaced.
D. For purposes of this section,
				"compensation" includes pecuniary or non-pecuniary remuneration of any kind
				relating to the sale or renewal of the policy or certificate including but not
				limited to bonuses, gifts, prizes, awards and finders fees.
Miss Code Ann §
										83-9-103(Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.19 - Filing Requirements For Advertising

Current through June 25, 2024
An issuer shall provide a copy of any Medicare supplement
				  advertisement intended for use in this state whether through written, radio or
				  television medium to the Commissioner of Insurance of this state for review or
				  approval by the commissioner to the extent it may be required under state law.
Miss Code Ann §
										83-9-103(Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.20 - Standards for Marketing

Current through June 25, 2024
A. An issuer,
				directly or through its producers, shall:
1.
				Establish marketing procedures to assure that any comparison of policies by its
				agents or other producers will be fair and accurate.
2. Establish marketing procedures to assure
				excessive insurance is not sold or issued.
3. Display prominently by type, stamp or
				other appropriate means, on the first page of the policy the following:
"Notice to buyer: This policy may not cover all of your
				  medical expenses."
4. Inquire and otherwise make every
				reasonable effort to identify whether a prospective applicant or enrollee for
				Medicare supplement insurance already has accident and sickness insurance and
				the types and amounts of any such insurance.
5. Establish auditable procedures for
				verifying compliance with this Subsection A.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.21 - Appropriateness of Recommended Purchase and Excessive Insurance

Current through June 25, 2024
A. In recommending the purchase or
				replacement of any Medicare supplement policy or certificate an agent shall
				make reasonable efforts to determine the appropriateness of a recommended
				purchase or replacement.
B. Any
				sale of a Medicare supplement policy or certificate that will provide an
				individual more than one Medicare supplement policy or certificate is
				prohibited.
C. An issuer shall not
				issue a Medicare supplement policy or certificate to an individual enrolled in
				Medicare Part C unless the effective date of the coverage is after the
				termination date of the individual's Part C coverage
Miss Code Ann §
										83-9-103(Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.22 - Reporting Of Multiple Policies

Current through June 25, 2024
A. On or before
				March 1 of each year, an issuer shall report the following information for
				every individual resident of this state for which the issuer has in force more
				than one Medicare supplement policy or certificate:
1. Policy and certificate number; and
2. Date of issuance.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.23 - Prohibition against Preexisting Conditions, Waiting Periods, Elimination Periods And Probationary Periods in Replacement Policies or Certificates

Current through June 25, 2024
A. If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate, the
				replacing issuer shall waive any time periods applicable to preexisting
				conditions, waiting periods, elimination periods and probationary periods in
				the new Medicare supplement policy or certificate for similar benefits to the
				extent such time was spent under the original policy.
B. If a Medicare supplement policy or
				certificate replaces another Medicare supplement policy or certificate which
				has been in effect for at least six (6) months, the replacing policy shall not
				provide any time period applicable to preexisting conditions, waiting periods,
				elimination periods and probationary periods for benefits similar to those
				contained in the original policy or certificate.
Miss Code Ann §
										83-9-103(Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.24 - Prohibition Against use of Genetic Information and Requests for Genetic Testing

Current through June 25, 2024
This Section applies to all policies with policy years
				  beginning on or after May 21, 2009.
A. An issuer of a Medicare supplement policy
				or certificate;
1. Shall not deny or
				condition the issuance or effectiveness of the policy or certificate (including
				the imposition of any exclusion of benefits under the policy based on a
				pre-existing condition) on the basis of the genetic information with respect to
				such individual; and
2. Shall not
				discriminate in the pricing of the policy or certificate (including the
				adjustment of premium rates) of an individual on the basis of the genetic
				information with respect to such individual.
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.25 - Separability

Current through June 25, 2024
If any provision of this regulation or the application
				  thereof to any person or circumstance is for any reason held to be invalid, the
				  remainder of the regulation and the application of such provision to other
				  persons or circumstances shall not be affected thereby
Miss Code Ann §
										83-9-115(Rev.
				  2011)
Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.26 - Effective Date

Current through June 25, 2024
This regulation
and its amendments
shall be effective on
and after January 1, 2020
.
Miss Code Ann §
										25-43-3.113(Rev.
				  2010)