Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.507 - BENEFIT STANDARDS FOR MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED OR DELIVERED WITH AN EFFECTIVE DATE FOR COVERAGE PRIOR TO JUNE 1, 2010

Current through Register Vol. 13, July 5, 2024
(1) 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 prior to 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 standards.
(a) the following
				standards are in addition to all other requirements of this subchapter and
				Title 33, chapter 22, part 9, MCA, Medicare Supplement Insurance Minimum
				Standards:
(i) a Medicare supplement policy
				or certificate shall not exclude or limit benefits for a loss incurred more
				than six months from the effective date of coverage because it involves 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
				months before the effective date of coverage;
(ii) a Medicare supplement policy or
				certificate must not indemnify against losses resulting from sickness on a
				different basis than losses resulting from accidents;
(iii) A Medicare supplement policy or
				certificate must 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;
(iv) no Medicare supplement policy or
				certificate may 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;
(v) each Medicare supplement policy shall be
				guaranteed renewable and:
(A) the issuer
				shall not cancel or nonrenew the policy solely on the ground of health status
				of the individual; and
(B) the
				issuer shall not cancel or nonrenew the policy for any reason other than
				nonpayment of premium or material misrepresentation;
(vi) if the Medicare supplement policy is
				terminated by the group policyholder and is not replaced as provided under
				(1)(a)(viii), the issuer must offer certificateholders an individual Medicare
				supplement policy which (at the option of the certificateholder):
(A) provides for continuation of the benefits
				contained in the group policy; or
(B) provides for such benefits as are
				required to meet the minimum standards as defined in
				6.6.507D(4) 
				];
(vii) if an
				individual is a certificateholder in a group Medicare supplement policy and the
				individual terminates membership in the group, the issuer shall:
(A) offer the certificateholder the
				conversion opportunity described in (1)(a)(vi);
(B) at the option of the group policyholder,
				offer the certificateholder continuation of coverage under the group
				policy;
(viii) 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 policy must not result in any
				exclusion for preexisting conditions that would have been covered under the
				group policy being replaced; and
(ix) if a Medicare supplement policy or
				certificate eliminates an outpatient prescription drug benefit as a result of
				requirements imposed by the Medicare Prescription Drug, Improvement and
				Modernization Act of 2003 (MMA), the modified policy or certificate shall be
				deemed to satisfy the guaranteed renewal requirements of this rule.