Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 13 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 365:10-5-126 - Minimum benefit standards for policies or certificates issued for delivery prior to July 1, 1992

Current through Vol. 41, No. 20, July 1,
				  2024
(a)
Minimum
				  standards.
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.
(b)
General standards.
The
				  following standards apply to Medicare supplement policies and certificates and
				  are in addition to all other requirements of this Part.
(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 amount and copayment percentage factors.
				  Premiums may be modified to correspond with such changes.
(4) A "noncancellable," "guaranteed
				  renewable," or "noncancellable 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
				  nonrenewed by the issuer solely on the grounds of deterioration of
				  health.
(5) 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.
(A) If a group Medicare supplement insurance
				  policy is terminated by the group policyholder and not replaced as provided in
				  (b)(5)(C) of this section, the issuer shall offer certificateholders an
				  individual Medicare supplement policy. The issuer shall offer the
				  certificateholder 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; or
(ii) An individual Medicare supplement policy
				  which provides only such benefits as are required to meet the minimum standards
				  as defined in
				  365:10-5-127(c).
(B) If membership in a group is
				  terminated, the issuer shall:
(i) Offer the
				  certificateholder such conversion opportunities as are described in (b)(5)(A)
				  of this section; or
(ii) At the
				  option of the group policyholder, offer the certificateholder continuation of
				  coverage under the group policy.
(C) If a group Medicare supplement policy is
				  replaced by another group Medicare supplement policy purchased by the same
				  policyholder, the succeeding issuer 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.