Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 37 - Medicare Supplement Insurance › Rule 191-37.6 - Minimum Benefit Standards for Prestandardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to January 1, 1992 (prestandardized plans)

Current through Register Vol. 47, No. 3, July 24, 2024
No policy or certificate may be advertised, solicited or
				  issued for delivery in this state as a prestandardized plan 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 prestandardized plans and are in addition to all
				other requirements of this chapter.
a. A
				prestandardized plan shall not exclude or limit benefits for losses incurred
				more than six months from the effective date of coverage because it involved a
				preexisting condition. The prestandardized plan 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
				months before the effective date of coverage.
b. A prestandardized plan shall not indemnify
				against losses resulting from sickness on a different basis than losses
				resulting from accidents.
c. A
				prestandardized plan 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.
d. A "noncancelable," "guaranteed renewable,"
				or "noncancelable and guaranteed renewable" prestandardized plan shall not:
(1) Provide for termination of coverage of a
				spouse of a group member solely because of the occurrence of an event specified
				for termination of coverage of the group member, other than the nonpayment of
				premium; or
(2) Be canceled or
				nonrenewed by the issuer solely on the grounds of deterioration of
				health.
e. Except as
				authorized by the commissioner, an issuer shall neither cancel nor nonrenew a
				prestandardized plan policy or certificate for any reason other than nonpayment
				of premium or material misrepresentation.
f. Group Medicare supplement policies.
(1) If a group prestandardized plan is
				terminated by the group policyholder and not replaced as provided in
				subparagraph 37.6(1)
"f"
(3), the issuer shall offer to each of
				the covered individuals under the group prestandardized plan an individual
				Medicare supplement policy. The issuer shall offer each of the group
				prestandardized plan's covered individuals at least the following choices:
1. An individual Medicare supplement policy
				currently offered by the issuer having comparable benefits to those contained
				in the terminated group prestandardized plan; and
2. An individual Medicare supplement policy
				which provides only such benefits as are required to meet the basic core
				benefits minimum standards as defined in subrule 37.7(2).
(2) If a covered individual's membership with
				the group entity that is the group policyholder is terminated, the issuer
				shall:
1. Offer the covered individual such
				conversion opportunities as are described in subparagraph
				37.6(1)
"f"
(1); or
2. At the option of the group policyholder,
				offer the covered individual continuation of coverage under the group
				prestandardized plan.
(3) If a group prestandardized plan is
				replaced by another group Medicare supplement policy purchased by the same
				group policyholder, the issuer of the replacement group Medicare supplement
				policy shall offer coverage to all covered individuals under the replaced group
				prestandardized plan on its date of termination. Coverage under the new
				replacement group Medicare supplement policy shall not result in any exclusion
				for preexisting conditions that would have been covered under the replaced
				group prestandardized plan.
(4) If
				a prestandardized plan eliminates an outpatient prescription drug benefit as a
				result of requirements imposed by the MMA, the modified policy shall be deemed
				to satisfy the guaranteed renewal requirements of this
				subrule.
g. Termination
				of a prestandardized plan policy or certificate shall be without prejudice to
				any continuous loss which commenced while the prestandardized plan policy or
				certificate was in force, but the extension of benefits beyond the period
				during which the prestandardized plan policy or certificate was in force may be
				predicated upon the continuous total disability of the covered individual,
				limited to the duration of the prestandardized plan policy or certificate
				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.