Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.07

Current through June 25, 2024
Minimum Benefit Standards for Pre-Standardized Medicare
				  Supplement Benefit Plan Policies or Certificates Issued For Delivery Prior To
				  July 1, 1992
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.
A. General Standards. The following standards
				apply to Medicare supplement policies and certificates and are in addition to
				all other requirements of this regulation.
1.
				A Medicare supplement policy or certificate shall not exclude or limit benefits
				for losses incurred more than six (6) 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 (6) months before the effective date of coverage.
2. A Medicare supplement policy or
				certificate shall not indemnify against losses resulting from sickness on a
				different basis than losses resulting from accidents.
3. 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, co-payment, or coinsurance amounts.Premiums
				may be modified to correspond with such changes.
4. A "non-cancellable," "guaranteed
				renewable," or "non-cancellable and guaranteed renewable" Medicare supplement
				policy shall not:
a. 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
b. Be cancelled or
				non-renewed by the issuer solely on the grounds of deterioration of health.
5.
a.
Except as authorized by the commissioner of this state, an
				  issuer shall neither cancel nor non-renew a Medicare supplement policy or
				  certificate for any reason other than nonpayment of premium or material
				  misrepresentation.
b. If a
				group Medicare supplement insurance policy is terminated by the group
				policyholder and not replaced as provided in Paragraph (5)(d), the issuer shall
				offer certificate holders an individual Medicare supplement policy. The issuer
				shall offer the certificate holder at least the following choices:
i. An individual Medicare supplement policy
				currently offered by the issuer having comparable benefits to those contained
				in the terminated group Medicare supplement policy; and
ii. An individual Medicare supplement policy
				which provides only such benefits as are required to meet the minimum standards
				as defined in Rule 10.08.1 B of this regulation.
c. If membership in a group is terminated,
				the issuer shall:
i. Offer the certificate
				holder the conversion opportunities described in Subparagraph (b); or
ii. At the option of the group
				policyholder, offer the certificate holder continuation of coverage under the
				group policy.
d. 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.
6. 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.
7. 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.