Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-8.1 - Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

Current through July 13, 2024
The following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  state with an effective date for coverage on or after June 1, 2010. No policy
				  or certificate may be advertised, solicited, delivered, or issued for delivery
				  in this state as a Medicare supplement policy or certificate unless it complies
				  with these benefit standards No issuer may offer any 1990 Standardized Medicare
				  supplement benefit plan for sale on or after June 1, 2010. Benefit standards
				  applicable to Medicare supplement policies and certificates issued with an
				  effective date for coverage prior June 1, 2010 remain subject to the
				  requirements of Section
				  8.
(a) General Standards. The following
				standards apply to Medicare supplement policies and certificates and are in
				addition to all other requirements of this regulation.
(i) A Medicare supplement policy or
				certificate shall not exclude or limit benefits for losses incurred more than
				ninety (90) days from the effective date of coverage because it involved a
				preexisting condition. The policy or certificate may 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
				ninety (90) days before the effective date of coverage.
(ii) A Medicare supplement policy or
				certificate shall not indemnify against losses resulting from sickness on a
				different basis than losses resulting from accidents.
(iii) 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.
(iv) No Medicare supplement policy or
				certificate shall 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.
(v) Each Medicare supplement policy shall be
				guaranteed renewable.
(A) The issuer shall not
				cancel or non-renew the policy solely on the ground of health status of the
				individual.
(B) The issuer shall
				not cancel or non-renew the policy for any reason other than nonpayment of
				premium or material misrepresentation.
(C) If the Medicare supplement policy is
				terminated by the group policyholder and is not replaced as provided under
				Section 8.1(a)(v)(E) of this regulation, the issuer shall offer certificate
				holders an individual Medicare supplement policy which (at the option of the
				certificate holder):
(I) Provides for
				continuation of the benefits contained in the group policy; or
(II) Provides for benefits that otherwise
				meet the requirements of this Subsection.
(D) If an individual is a certificate holder
				in a group Medicare supplement policy and the individual terminates membership
				in the group, the issuer shall:
(I) Offer the
				certificate holder the conversion opportunity described in Section 8.1(a)(v)(C)
				of this regulation; or
(II) At the
				option of the group policyholder, offer the certificate holder continuation of
				coverage under the group policy.
(E) 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 policy shall not result in any exclusion for preexisting
				conditions that would have been covered under the group policy being
				replaced.
(vi)
				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 conditioned upon the continuous total disability of the insured,
				limited to the duration of the policy benefit period, if any, or payment of the
				maximum benefits. Receipt of Medicare Part D benefits will not be considered in
				determining a continuous loss.
(vii) Suspension.
(A) A Medicare supplement policy or
				certificate shall provide that benefits and premiums under the policy or
				certificate shall be suspended at the request of the policyholder or
				certificate holder for the period (not to exceed twenty-four (24) months) in
				which the policyholder or certificate holder has applied for and is determined
				to be entitled to medical assistance under Title XIX of the Social Security
				Act, but only if the policyholder or certificate holder notifies the issuer of
				the policy or certificate within ninety (90) days after the date the individual
				becomes entitled to assistance.
(B)
				If suspension occurs and if the policyholder or certificate holder loses
				entitlement to medical assistance, the policy or certificate shall be
				automatically reinstituted (effective as of the date of termination of
				entitlement) as of the termination of entitlement if the policyholder or
				certificate holder provides notice of loss of entitlement within ninety (90)
				days after the date of loss and pays the premium attributable to the period,
				effective as of the date of termination of entitlement.
(C) Each Medicare supplement policy shall
				provide that benefits and premiums under the policy shall be suspended (for any
				period that may be provided by federal regulation) at the request of the
				policyholder if the policyholder is entitled to benefits under Section 226(b)
				of the Social Security Act and is covered under a group health plan (as defined
				in Section 1862(b)(1)(A)(v) of the Social Security Act). If suspension occurs
				and if the policyholder or certificate holder loses coverage under the group
				health plan, the policy shall be automatically reinstituted (effective as of
				the date of loss of coverage) if the policyholder provides notice of loss of
				coverage within ninety (90) days after the date of the loss.
(D) Reinstitution of coverages.
(I) Shall not provide for any waiting period
				with respect to treatment of preexisting conditions;
(II) Shall provide for resumption of coverage
				that is substantially equivalent to coverage in effect before the date of
				suspension; and
(III) Shall provide
				for classification of premiums on terms at least as favorable to the
				policyholder or certificate holder as the premium classification terms that
				would have applied to the policyholder or certificate holder had the coverage
				not been suspended.