Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 71.00 - Medicare Supplement Insurance To Facilitate The Implementation Of M.G.L. c. 176k And Section 1882 Of The Federal Social Security Act › Section 71.07 - Renewability

Current through Register 1525, July 5, 2024
(1) Medicare Supplement Insurance Policies
			 shall include a renewability provision. The language or specifications of the
			 provision shall be consistent with the type of contract issued. Medicare
			 Supplement Insurance Policies, including Alternate Innovative Benefit Riders,
			 shall not contain renewal provisions less favorable to the Insured than
			 "Guaranteed Renewable" as that term is defined in
			 211 CMR
			 71.03.
(2) All Medicare Supplement Insurance
			 Policies, including Alternate Innovative Benefit Riders, shall contain a
			 renewability provision as required by 211 CMR 71.07(1). Such provision shall be
			 appropriately captioned and shall appear on the first page of the Policy and
			 shall include any reservation by the Issuer of the right to change
			 premiums.
(3) Medicare Supplement
			 Insurance Policies shall comply with the following requirements:
(a) The Issuer shall not cancel or nonrenew
			 the Policy solely on the ground of the health status of the
			 individual.
(b) The Issuer shall
			 not cancel or nonrenew the Policy, including an Alternate Innovative Benefit
			 Rider, for any reason other than nonpayment of premium or material
			 misrepresentation; provided that no Nonprofit Hospital Service Corporation or
			 Medical Service Corporation shall be required to continue the coverage of a
			 Policyholder who becomes a resident of a state other than
			 Massachusetts.
(c) If the Medicare
			 Supplement Insurance Policy is held by a group, and the group policy is
			 terminated and is not replaced, as provided under 211 CMR 71.07(3)(e), the
			 Issuer shall offer certificateholders an individual Medicare Supplement
			 Insurance Policy which, at the option of the certificateholder:
1. Provides for continuation of the benefits
			 contained in the group Policy; or
2. Provides for benefits that otherwise meet
			 the requirements of 211 CMR 71.07(3).
(d) If an individual is a certificateholder
			 in a group Medicare Supplement Insurance Policy and the individual terminates
			 membership in the group, the Issuer shall:
1.
			 Offer the certificateholder the conversion opportunity described in 211 CMR
			 71.07(3)(c); or
2. At the option of
			 the group Policyholder, offer the certificateholder continuation of coverage
			 under the group Policy.
(e) If a group Medicare Supplement Insurance
			 Policy is replaced by another group Medicare Supplement Insurance 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 Policy shall not contain any waiting period
			 or preexisting condition limitation or exclusion.
(f) Termination of a Medicare Supplement
			 Insurance Policy 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 conditioned upon the
			 continuous total disability of the Insured, limited to the duration of the
			 Policy benefit period, if any, or payment of the maximum benefits. Receipt of
			 Medicare Part D benefits will not be considered in determining a continuous
			 loss.
(g)
General
			 Standards
. The following standards apply to Medicare Supplement
			 Insurance Policies and are in addition to all other requirements of
			 211 CMR 71.00.
1. A Medicare Supplement Insurance Policy
			 shall provide that benefits and premiums under the Policy shall be suspended at
			 the request of the Policyholder for the period (not to exceed 24 months, unless
			 the Issuer permits a longer period of suspension) in which the Policyholder has
			 applied for and is determined to be entitled to medical assistance under Title
			 XIX of the Social Security Act, but only if the Policyholder notifies the
			 Issuer of such Policy within 90 days after the date the individual becomes
			 entitled to such assistance.
2. If
			 suspension occurs and if the Policyholder loses entitlement to medical
			 assistance, the Policy shall be automatically reinstituted (effective as of the
			 date of termination of such entitlement) if the Policyholder provides notice of
			 loss of entitlement within 90 days after the date of loss and pays the premium
			 attributable to the period, effective as of the date of termination of
			 entitlement.
3. Each Medicare
			 Supplement Insurance Policy shall provide that benefits and premiums under the
			 Policy shall be suspended (for any period that may be provided by federal
			 regulation) at the request of the Policyholder if the Policyholder is entitled
			 to benefits under the Social Security Act § 226(b) and is covered under a
			 group health plan (as defined in the Social Security Act §
			 1862(b)(1)(A)(v)). If suspension occurs and if the Policyholder loses coverage
			 under the group health plan, the Policy shall be automatically reinstituted
			 (effective as of the date of loss of coverage) if the Policyholder provides
			 notice of loss of coverage within 90 days after the date of the loss.
4. Reinstitution of such coverages as
			 described in 211 CMR 71.07(3)(g)3. and 4.:
a.
			 Shall not provide for any waiting period with respect to treatment of
			 preexisting conditions;
b. Shall
			 provide for coverage which is substantially equivalent to coverage in effect
			 before the date of such suspension. If the suspended Medicare Supplement
			 Insurance Policy provided coverage for outpatient prescription drugs,
			 reinstitution of the Policy for Medicare Part D enrollees shall be without
			 coverage for outpatient prescription drugs and shall otherwise provide
			 substantially equivalent coverage to the coverage in effect before the date of
			 suspension; and
c. Shall provide
			 for classification of premiums on terms at least as favorable to the
			 Policyholder as the premium classification terms that would have applied to the
			 Policyholder had the coverage not been suspended.