Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 3 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Rule 15 - Requirements for Application Forms and Replacement Coverage › Section 15-1 - Application forms and replacement coverage

Current through July 10, 2024
Authority: IC
				  27-8-13-10;
				  IC
				  27-8-13-16
Affected: IC
				  27-8-13-1
Sec. 1.
(a)
				Application forms shall include statements and questions as established in this
				subsection designed to elicit information as to whether, as of the date of the
				application, the applicant currently has another Medicare supplement, Medicare
				Advantage, or Medicaid coverage or another health insurance policy or
				certificate in force or whether a Medicare supplement policy or certificate is
				intended to replace any other accident and sickness policy or certificate
				presently in force. A supplementary application or other form to be signed by
				the applicant and agent containing questions and statements may be used, such
				as the following:
(1) The following
				statements:
(A) You do not need more than one
				(1) Medicare supplement policy.
(B)
				If you purchase this policy, you may want to evaluate your existing health
				coverage and decide if you need multiple coverages.
(C) You may be eligible for benefits under
				Medicaid and may not need a Medicare supplement policy.
(D) If, after purchasing this policy, you
				become eligible for Medicaid, the benefits and premiums under your Medicare
				supplement policy can be suspended, if requested, during your entitlement to
				benefits under Medicaid for twenty-four (24) months. You must request this
				suspension within ninety (90) days of becoming eligible for Medicaid. If you
				are no longer entitled to Medicaid, your suspended Medicare supplement policy
				(or, if that is no longer available, a substantially equivalent policy) will be
				reinstituted if requested within ninety (90) days of losing Medicaid
				eligibility. If the Medicare supplement policy provided coverage for outpatient
				prescription drugs and you enrolled in Medicare Part D while your policy was
				suspended, the reinstituted policy will not have outpatient prescription drug
				coverage but will otherwise be substantially equivalent to your coverage before
				the date of the suspension.
(E) If
				you are eligible for and have enrolled in a Medicare supplement policy by
				reason of disability and you later become covered by an employer or union-based
				group health plan, the benefits and premiums under your Medicare supplement
				policy can be suspended, if requested, while you are covered under the employer
				or union-based group health plan. If you suspend your Medicare supplement
				policy under these circumstances and later lose your employer or union-based
				group health plan, your suspended Medicare supplement policy (or, if that is no
				longer available, a substantially equivalent policy) will be reinstituted if
				requested within ninety (90) days of losing your employer or unionbased group
				health plan. If the Medicare supplement policy provided coverage for outpatient
				prescription drugs and you enrolled in Medicare Part D while your policy was
				suspended, the reinstituted policy will not have outpatient prescription drug
				coverage but will otherwise be substantially equivalent to your coverage before
				the date of the suspension.
(F)
				Counseling services may be available in your state to provide advice concerning
				your purchase of Medicare supplement insurance and concerning medical
				assistance through the state Medicaid program, including benefits as Qualified
				Medicare Beneficiary (QMB) and a Specified Low-Income Medicare Beneficiary
				(SLMB).