Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter K - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 89.784 - Requirements for application forms and replacement coverage

Current through Register Vol. 54, No. 28, July 13, 2024
Application forms shall include the following requirements
					 and questions designed to elicit information as to whether, as of the date of
					 application, the applicant currently has Medicare supplement, Medicare
					 Advantage, Medicaid coverage, or another health insurance policy or certificate
					 in force or whether a Medicare supplement policy or certificate is intended to
					 replace any other accident and sickness policy or certificate presently in
					 force. A supplementary application or other form to be signed by the applicant
					 and producer containing these questions and statements may be used. In the case
					 of a direct response issuer, a copy of the application or supplemental form,
					 signed by the applicant, and acknowledged by the insurer, shall be returned to
					 the applicant by the insurer upon delivery of the policy.
(1)
Statements
.
(i) You do not need more than one Medicare
				  supplement policy.
(ii) If you
				  purchase this policy, you may want to evaluate your existing health coverage
				  and decide if you need multiple coverages.
(iii) You may be eligible for benefits under
				  Medicaid and may not need a Medicare supplement policy.
(iv) If, after purchasing this policy, you
				  become eligible for Medicaid, the benefits and premiums under your Medicare
				  supplement policy can be suspended, if requested, during your entitlement to
				  benefits under Medicaid for 24 months. You must request this suspension within
				  90 days of becoming eligible for Medicaid. If you are no longer entitled to
				  Medicaid, your suspended Medicare supplement policy or, if the Medicare
				  supplement policy is no longer available, a substantially equivalent policy
				  will be reinstituted if requested within 90 days of losing Medicaid
				  eligibility. If the Medicare supplement policy provided coverage for outpatient
				  prescription drugs and you enrolled in Medicare Part D while your policy was
				  suspended, the reinstituted policy will not have outpatient prescription drug
				  coverage, but will otherwise be substantially equivalent to your coverage
				  before the date of suspension.
(v)
				  If you are eligible for, and have enrolled in a Medicare supplement policy by
				  reason of disability and you later become covered by an employer or union-based
				  group health plan, the benefits and premiums under your Medicare supplement
				  policy can be suspended, if requested, while you are covered under the employer
				  or union-based group health plan. If you suspend your Medicare supplement
				  policy under these circumstances, and later lose your employer or union-based
				  group health plan, your suspended Medicare supplement policy (or, if that is no
				  longer available, a substantially equivalent policy) will be reinstituted if
				  requested within 90 days of losing your employer or union-based group health
				  plan. If the Medicare supplement policy provided coverage for outpatient
				  prescription drugs and you enrolled in Medicare Part D while your policy was
				  suspended, the reinstituted policy will not have outpatient prescription drug
				  coverage, but will otherwise be substantially equivalent to your coverage
				  before the date of suspension.
(vi)
				  Counseling services may be available in your state to provide advice concerning
				  your purchase of Medicare supplement insurance and concerning medical
				  assistance through the state Medicaid program, including benefits as a
				  Qualified Medicare Beneficiary (QMB) and a Specified Low-Income Medicare
				  Beneficiary (SLMB).