Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-510 - Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to July 20, 1992

Current through Register Vol. 50, No. 6, June 20, 2024
A. 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 which 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 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
				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 to correspond with such changes.
d. A noncancellable, guaranteed renewable, or
				noncancellable and guaranteed renewable Medicare supplement policy shall not:
i. 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
ii. be cancelled or nonrenewed by the issuer
				solely on the grounds of deterioration of health.
e.
i. Except
				as authorized by the commissioner 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.
ii. If a group Medicare supplement insurance
				policy is terminated by the group policyholder and not replaced as provided in
				§510. A.1.e iv, the issuer shall offer certificateholders an individual
				Medicare supplement policy. The issuer shall offer the certificateholder at
				least the following choices:
(a). an
				individual Medicare supplement policy currently offered by the issuer having
				comparable benefits to those contained in the terminated group Medicare
				supplement policy; and
(b). an
				individual Medicare supplement policy which provides only such benefits as are
				required to meet the minimum standards as defined in §516. A.2 of this
				regulation;
(c). group contracts in
				force prior to the effective date of the Omnibus Budget Reconciliation Act
				(OBRA) of 1990 may have existing contractual obligations to continue benefits
				contained in the group contract. This Section is not intended to impair those
				obligations.
iii. If
				membership in a group is terminated, the issuer shall:
(a). offer the certificateholder the
				conversion opportunities described in §510. A.1.e ii; or
(b). at the option of the group policyholder,
				offer the certificateholder continuation of coverage under the group
				policy.
iv. 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 which
				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.