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 71.08 - Policy Benefit Standards

Current through Register 1525, July 5, 2024
(1) A Medicare
			 Supplement Insurance Policy shall not be advertised, solicited, delivered,
			 issued, issued for delivery or renewed, unless the Policy meets the following
			 requirements:
(a) A Medicare Supplement
			 Insurance Policy shall not indemnify against losses resulting from sickness on
			 a different basis than losses resulting from accidents.
(b) Any Medicare Supplement Insurance Policy
			 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 amount and copayment percentage factors and any
			 Medicare Supplement Insurance Policy issued to be effective on or after January
			 1, 2006 shall provide that benefits will be changed automatically to coincide
			 with any changes required under Massachusetts law regarding mandated benefits;
			 premiums may be modified to correspond with such changes, if approved by the
			 Commissioner in accordance with statutory and regulatory requirements; provided
			 however, that such Policy shall provide that the Insured agrees to the change
			 of benefits and premiums based on changes required under Massachusetts law
			 regarding mandated benefits; provided further that, except as otherwise
			 required by law, all Medicare Supplement Insurance Policies originally issued
			 to be effective prior to January 1, 2006 shall maintain any Guaranteed
			 Renewable fixed drug deductible and the same benefits covered in the original
			 Policy; and provided further that, except as otherwise required by law, all
			 Medicare Supplement Insurance Policies originally issued to be effective prior
			 to January 1, 2020 shall maintain any Guaranteed Renewable benefit to cover the
			 Medicare Part B deductible and the same benefits covered in the original
			 Policy.
(c) No Medicare Supplement
			 Insurance Policy shall contain benefits that duplicate benefits provided by
			 Medicare.
(d) No Medicare
			 Supplement Insurance Policy shall contain any waiting period or preexisting
			 condition limitation or exclusion.
(e) No Medicare Supplement Insurance Policy
			 shall 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.
(f) Each Medicare Supplement Insurance Policy
			 shall be Guaranteed Renewable in accordance with the provisions of
			 211 CMR
			 71.07.
(g) No Medicare Supplement Insurance Policy
			 issued to be effective on or before December 31, 2005, which provides coverage
			 for prescription drugs, shall exclude coverage of any such drug for the
			 treatment of cancer or HIV/AIDS on the ground that the off-label use of the
			 drug has not been approved by the United States Food and Drug Administration
			 for that indication; provided however, that such drug is recognized for
			 treatment of such indication in one of the standard reference compendia; or in
			 the medical literature, as those terms are defined in M.G.L. c. 175, §
			 47O, or by the Commissioner under the provisions of M.G.L. c. 175, §
			 47P.
(h) An Issuer of a Medicare
			 Supplement Insurance Policy shall refund the unearned portion of any premium
			 paid on a quarterly, semi-annual or annual basis upon the death of a
			 Policyholder. An Issuer of a Medicare Supplement Insurance Policy may refund
			 the unearned portion of any premium paid on a quarterly, semi-annual or annual
			 basis in the case of cancellation by the Policyholder for reasons other than
			 death. When calculating all such refunds, an Issuer of a Medicare Supplement
			 Insurance Policy shall convert the billing mode from annual, semi-annual, or
			 quarterly to monthly as of the date of death or cancellation by the
			 Policyholder for reasons other than death and refund the premium paid less the
			 sum of the monthly premiums earned to that point or use a refund methodology
			 submitted to and approved by the Commissioner. All Medicare Supplement Issuers
			 shall notify applicants regarding premium refunds in the required outline of
			 coverage as set forth in
			 211 CMR
			 71.13(2)(c)2. Nothing in 211
			 CMR 71.08(1)(h) shall affect the rights of a Policyholder to return the Policy
			 within 30 days of its delivery and receive a premium refund pursuant to
			 211 CMR
			 71.13(1)(e).