Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0165 - Requirements for Application Forms, Replacement Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Application forms shall include the
			 statements and questions set forth in this section designed to elicit
			 information as to whether, as of the date of the 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 health
			 insurance policy or certificate currently in force. A supplementary application
			 or other form to be signed by the applicant and agent containing such
			 statements and questions may be used. The statements and questions are as
			 follows:
(a) Statements:
(A) You do not need more than one Medicare
			 supplement policy.
(B) If you
			 purchase this policy, you may want to evaluate your existing health coverage
			 and decide if you need multiple coverages.
(C) You may be eligible for benefits under
			 Medicaid and may not need a Medicare supplement policy.
(D) 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 that 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 the
			 suspension.
(E) 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 the suspension.
(F) 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).