Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.507D - BENEFIT STANDARDS FOR 2010 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY WITH AN EFFECTIVE DATE FOR COVERAGE ON OR AFTER JUNE 1, 2010

Current through Register Vol. 13, July 5, 2024
(1) The
				following standards are applicable to all Medicare supplement policies or
				certificates delivered or issued for delivery in this state with an effective
				date for coverage on or after June 1, 2010. No policy or certificate may be
				advertised, solicited, delivered or issued for delivery in this state as a
				Medicare supplement policy or certificate with an effective date for coverage
				on or after June 1, 2010, unless it complies with these benefit standards. No
				issuer may offer any 1990 Standardized Medicare Supplement Benefit Plan for
				sale on or after June 1, 2010. Benefit standards applicable to Medicare
				supplement policies and certificates issued with an effective date for coverage
				before June 1, 2010, remain subject to the requirements of ARM
				6.6.507 and other applicable rules
				and statutes contained in this subchapter and Title 33, chapter 22, part 9,
				MCA.
(a) The following standards are in
				addition to all other requirements of this subchapter and Title 33, chapter 22,
				part 9, MCA, Medicare Supplement Insurance Minimum Standards:
(i) a Medicare supplement policy or
				certificate must not exclude or limit benefits for a loss incurred more than
				six months from the effective date of coverage because it involves a
				preexisting condition. The policy or certificate may 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;
(ii) a Medicare supplement policy or
				certificate must not indemnify against losses resulting from sickness on a
				different basis than losses resulting from accidents;
(iii) a Medicare supplement policy or
				certificate must 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;
(iv) no Medicare supplement policy or
				certificate may 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;
(v) each Medicare supplement policy shall be
				guaranteed renewable and:
(A) the issuer
				shall not cancel or nonrenew the policy solely on the ground of health status
				of the individual; and
(B) the
				issuer shall not cancel or nonrenew the policy or certificate for any reason
				other than nonpayment of premium or material misrepresentation.
(vi) if the Medicare supplement
				policy is terminated by the group policyholder and is not replaced as provided
				under (1)(a)(viii), the issuer must offer certificateholders an individual
				Medicare supplement policy which (at the option of the certificateholder):
(A) provides for continuation of the benefits
				contained in the group policy; or
(B) provides for such benefits that meet the
				requirements of this subsection.
(vii) if an individual is a certificateholder
				in a group Medicare supplement policy and the individual terminates membership
				in the group, the issuer shall:
(A) offer the
				certificateholder the conversion opportunity described in (1)(a)(vi);
				or
(B) at the option of the group
				policyholder, offer the certificateholder continuation of coverage under the
				group policy.
(viii) 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 policy must not
				result in any exclusion for preexisting conditions that would have been covered
				under the group policy being replaced.