Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter T - MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 3.3309 - Requirements for Application Forms and Replacement Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Application forms shall include the
				  following information, statements and questions designed to elicit information
				  as to whether, as of the date of the application, the applicant currently has
				  another Medicare supplement, Medicare Advantage, Medicaid coverage, or other
				  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 currently in force. A supplementary application
				  or other form to be signed by the applicant and agent, except where the
				  coverage is sold without an agent, containing such questions may be used.
(1) The information shall be provided to
				  prospective covered persons in statement form conforming to subparagraphs (A) -
				  (F) of this paragraph.
(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 more than one
				  type of coverage in addition to your Medicare benefits.
(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).