Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 35 - MEDICARE SUPPLEMENT INSURANCE › Section 35-7 - Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to July 30, 1992

Current through July 13, 2024
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 standardsThese are
				  minimum standards and do not preclude the inclusion of other provisions or
				  benefits which are not inconsistent with these standards.
(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 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
				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) 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.
(v)
				Cancellation, termination, or non-renewal under this section.
(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
				Paragraph (v)(D), the issuer shall offer certificate holders an individual
				Medicare supplement policy. The issuer shall offer the certificate holder at
				least the following choices:
(I) An individual
				Medicare supplement policy currently offered by the issuer having comparable
				benefits to those contained in the terminated group Medicare supplement policy;
				and
(II) An individual Medicare
				supplement policy which provides only such benefits as are required to meet the
				minimum standards as defined in Section 8.1(b) of this regulation.
(C) If membership in a group is
				terminated, the issuer shall:
(I) Offer the
				certificate holder the conversion opportunities described in Subparagraph (b);
				or
(II) 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.
(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 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.
(vii) 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.