Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 30 - Health Insurance › Part 7 - Medicare Supplement Insurance Minimum Standards › Section 230-RICR-20-30-7.7 - Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to July 30, 1992

Current through June 14, 2024
A. 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, 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. Termination
				  of Policy
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
				  §
												7.7(B)(5) (d)   of this Part, the issuer shall offer certificate holders an
				  individual Medicare supplement policy. The issuer shall offer the certificate
				  holder at least the following choices:
(1) An
				  individual Medicare supplement policy currently offered by the issuer having
				  comparable benefits to those contained in the terminated group Medicare
				  supplement policy; and
(2) An
				  individual Medicare supplement policy which provides only such benefits as are
				  required to meet the minimum standards as defined in §
													7.9(C)   of this
				  Part.
c. If membership
				  in a group is terminated, the issuer shall:
(1) Offer the certificate holder the
				  conversion opportunities described in §
													7.7(B)(5)(b)   of this Part;
				  or
(2) 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.