Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-60 - Minimum benefit standards for prestandardized Medicare supplement benefits plan policies or certificates issued for delivery prior to July 30, 1992

Current through Register Vol. 40, No. 24, July 15, 2024
A. No
				policy or certificate may be advertised, solicited or issued for delivery in
				this Commonwealth 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 that are not
				inconsistent with these standards.
B. The following standards apply to Medicare
				supplement policies and certificates and are in addition to all other
				requirements of this chapter.
1. A Medicare
				supplement policy or certificate shall not exclude or limit benefits for a loss
				incurred more than six 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 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, copayment or coinsurance amounts. 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 canceled or
				nonrenewed by the issuer solely on the grounds of deterioration of
				health.
5.
a. Except as authorized by the State
				Corporation Commission, an issuer shall neither cancel nor nonrenew 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
				subdivision 5 d of this subsection, the issuer shall offer certificateholders
				an individual Medicare supplement policy. The issuer shall offer the
				certificateholder 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
				that provides only such benefits as are required to meet the minimum standards
				as defined in
				14VAC5-170-75 C.
c. If membership in a group is
				terminated, the issuer shall:
(1) Offer the
				certificateholder the conversion opportunities described in subdivision 5 b of
				this subsection; or
(2) At the
				option of the group policyholder, offer the certificateholder 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 is modified to eliminate an outpatient
				prescription drug benefit as a result of requirements imposed by the Medicare
				Prescription Drug, Improvement, and Modernization Act of 2003 (
				42 USC §
											1395w-101 ), the modified policy shall be
				deemed to satisfy the guaranteed renewal requirements of this
				subsection.