West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-16 - Requirements for Application Forms and Replacement Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
16.1. Application forms shall include the
				following questions 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 accident and sickness policy or certificate presently in force. A
				supplementary application or other form to be signed by the applicant and agent
				containing these questions and statements may be used.
16.1.a. Statements:
16.1.a.1. You do not need more than one Medicare
				supplement policy.
16.1.a.2. If you
				purchase this policy, you may want to evaluate your existing health coverage and
				decide if you need multiple coverages.
16.1.a.3. You may be eligible for benefits under
				Medicaid and may not need a Medicare supplement policy.
16.1.a.4. 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 ninety (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 ninety
				(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.
16.1.a.5. 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 ninety (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.
16.1.a.6. 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).