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31.10.06.00.htm 31.10.06.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 06 Standards for Medicare Supplement Policies Authority: Health-General Article, §19-705 and 19-706; Insurance Article, §2-109 and 8-403(b) Title 15, Subtitle 9, and Title 27; Annotated Code of Maryland
31.10.06.01.htm 31.10.06.01. 01 Applicability and Scope.. A. Except as otherwise provided in Regulations .10, .11, and .17 of this chapter, this chapter applies to all:1) Medicare supplement policies delivered or issued for delivery in this State; and. 2) Certificates issued under group Medicare supplement policies if the certificates are delivered or issued for delivery in this State.B. This chapter is applicable to all Medicare supplement policies and certificates under group Medicare supplement policies h
31.10.06.02.htm 31.10.06.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Adverse decision" has the meaning stated in Insurance Article, §15-10A-01, Annotated Code of Maryland.2) "Applicant" means:. a) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; andb) In the case of a group Medicare supplement policy, the proposed certificate holder.. 3) "Bankruptcy" means whe
31.10.06.03.htm 31.10.06.03. 03 Policy Definitions and Terms.. A. A policy or certificate may not be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy or certificate unless the policy or certificate contains definitions or terms which conform to the requirements of these regulations.B. Policy Terms Defined.. 1) Accident.. a) "Accident" "accidental injury" or "accidental means" shall be defined to employ "result" language.b) "Accident" "accidental
31.10.06.04.htm 31.10.06.04. 04 Filing and Approval of Policies and Certificates and Premium Rates.. A. An issuer may not deliver or issue for delivery a Medicare supplement policy or certificate to a resident of this State unless the policy form or certificate form has been filed with and approved by the Commissioner in accordance with filing requirements and procedures prescribed by applicable provisions of Insurance Article, §12-203, 12-205, and 14-126, Annotated Code of Maryland, and other ap
31.10.06.05.htm 31.10.06.05. 05 Filing Requirements for Advertising.. An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this State whether through written, radio, or television medium or otherwise, to the Commissioner for review by the Commissioner at least 5 business days before using the advertisement.
31.10.06.06.htm 31.10.06.06. 06 Open Enrollment.. A. Individuals 65 Years Old or Older and Enrolled in Medicare Part B.. 1) An issuer may not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of the policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant when an application for the policy or certificate is
31.10.06.07.htm 31.10.06.07. 07 Policy Provisions.. A. Except for permitted preexisting condition clauses as described in Regulations .08B and .27B(2) of this chapter, a policy or certificate may not be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.B. A Medicare supplement policy or certificate may not use waivers to exclu
31.10.06.08.htm 31.10.06.08. 08 Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plans.. A. General Standards.. 1) The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this State on or after July 14, 1992, and with an effective date for coverage before June 1, 2010.2) A policy or certificate may not be advertised, solicited, delivered, or issued for delivery in this State as a Medicare supplement policy or certif
31.10.06.09.htm 31.10.06.09. 09 Standard Medicare Supplement Benefit Plans for 1990 Plans.. A. Definitions.. 1) In this regulation, the following term has the meaning indicated.. 2) Term Defined. "Structure, language, and format" means style, arrangement, and overall content of a benefit.B. General Standards.. 1) The standards found in §C―I of this regulation are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this State on or after July 14, 1992, and with
31.10.06.09-1.htm 31.10.06.09-1. 09-1 Guaranteed Issue for Eligible Individuals.. A. Guaranteed Issue.. 1) Eligible individuals are those individuals described in §B of this regulation who:. a) Seek to enroll under the policy during the period specified in §C of this regulation; and. b) Submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the application for a Medicare supplement policy.2) With respect to eligible individuals, an issuer may not:. a) Deny or condition the
31.10.06.10.htm 31.10.06.10. 10 Standards for Claims Payment.. A. An issuer shall comply with §1882(c)3) of the Social Security Act, as enacted by §4081(b)2)C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Public Law No. 100-203, by:1) Accepting a notice from a Medicare carrier on dually assigned claims submitted by participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of
31.10.06.11.htm 31.10.06.11. 11 Loss Ratio Standards and Refund or Credit of Premium.. A. Loss Ratio Standards.. 1) An issuer may not deliver or issue for delivery a Medicare supplement policy form or certificate in this State unless the policy form or certificate can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to policyholders and certificate holders in the form of aggregate benefits, not including anticipated refunds or credits, provided under
31.10.06.12.htm 31.10.06.12. 12 Permitted Compensation Arrangements.. A. An issuer or other entity may provide commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is not more than 200 percent of the commission or other compensation paid for selling or servicing the policy or certificate in the second year or period.B. The commission or other compensation provided i
31.10.06.13.htm 31.10.06.13. 13 Required Disclosure Provisions.. A. Definitions.. 1) In this regulation, the following terms have the meanings indicated.. 2) Terms Defined.. a) "Form" means the language, format, type size, type proportional spacing, bold character, and line spacing.b) "Guide" means the Guide to Health Insurance for People with Medicare.. B. General Rules.. 1) Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifica
31.10.06.14.htm 31.10.06.14. 14 Requirements for Application Forms and Replacement Coverage.. A. Required Questions in Medicare Supplement Applications.. 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 inten
31.10.06.15.htm 31.10.06.15. 15 Standards for Marketing.. A. An issuer, directly or through its producers, shall:. 1) Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate;2) Establish marketing procedures to assure that excessive insurance is not sold or issued;. 3) Display prominently by type, stamp, or other appropriate means on the first page of the policy the following: "Notice to buyer: This policy may not
31.10.06.16.htm 31.10.06.16. 16 Appropriateness of Recommended Purchase and Excessive Insurance.. A. In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.B. Any sale of a Medicare supplement policy or certificate that will provide an individual more than one Medicare supplement policy or certificate is prohibited.C. An issuer may not issu
31.10.06.17.htm 31.10.06.17. 17 Report of Multiple Policies.. A. On or before March 1 of each year, an issuer shall report the following information for every individual resident of this State for which the issuer has in force more than one Medicare supplement policy or certificate:1) Policy or certificate number; and. 2) Date of issuance.. B. The items set forth in §A of this regulation shall be grouped by individual policyholder..
31.10.06.18.htm 31.10.06.18. 18 Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods, and Probationary Periods in Replacement Policies or Certificates.A. If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new Medicare supplement policy or certificate to the exte
31.10.06.19.htm 31.10.06.19. 19 Report Form for Calculation of Loss Ratios.. The following forms are to be used for reporting loss ratios and calculating refunds for credits required under Regulation .11B of this chapter:A. Medicare Supplement Refund Calculation Form.. MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR _. TYPE1_. SMSBP2_. For the State of_. Company Name _. NAIC Group Code _. NAIC Company Code _. Address _. Person Completing This Exhibit _. Title _. Telephone Number _. line.
31.10.06.20.htm 31.10.06.20. 20 Form for Reporting Multiple Policies.. The following form is to be used in making reports of multiple policies in accordance with the requirements of Regulation .17 of this chapter:FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES. Company name:. Address:. Phone Number:. Due: March 1, annually. The purpose of this form is to report the following information on each resident of this state who has in force more than one Medicare supplement policy or certificate. The in
31.10.06.21.htm 31.10.06.21. 21 Severability.. If any regulations of this chapter or the application of these regulations to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the regulations to other persons or circumstances may not be affected.
31.10.06.22.htm 31.10.06.22. 22 Disclosure Statements.. A. Instructions.. Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare1) Section 1882(d) of the federal Social Security Act (42 U.S.C. 1395ss) prohibits the sale of a health insurance policy (the term policy includes certificate) to Medicare beneficiaries that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary's other health cover
31.10.06.23.htm 31.10.06.23. 23 Disclosure Statements Printed After December 31, 2005.. A. Instructions.. 1) The instructions found in Regulation .22A(1)8) of this chapter also apply to the disclosure statements printed after December 31, 2005.2) Use of Original or Alternative Disclosure Statements.. a) Section 1882 of the federal Social Security Act was amended in Subsection (d)3)A) to allow for alternative disclosure statb) Carriers may use either disclosure statement with the requisite insurance product..
31.10.06.24.htm 31.10.06.24. 24 Medicare Select Policies and Certificates ― General Requirements.. A. Applicability.. 1) This regulation applies to Medicare Select policies and certificates, as defined in Regulation .02 of this chapter.2) A policy or certificate may not be advertised as a Medicare Select policy or certificate unless it meets the requirements of this regulation.B. The Commissioner may authorize an issuer to offer a Medicare Select policy or certificate pursuant to this regulation and
31.10.06.25.htm 31.10.06.25. 25 Medicare Select ― Consumer Protection.. A. Applicability.. 1) This regulation shall apply to Medicare Select policies and certificates, as defined in Regulation .02 of this chapter.2) A policy or certificate may not be advertised as a Medicare Select policy or certificate unless it meets the requirements of this regulation.B. Required Disclosure.. 1) A Medicare Select issuer shall make full and fair disclosure in writing of the provisions, restrictions, and limitations o
31.10.06.26.htm 31.10.06.26. 26 Prohibition Against Use of Genetic Information and Requests for Genetic Testing.. A. This regulation applies to all policies with policy years beginning on or after July 1, 2009.. B. Definitions.. 1) In this regulation, the following terms have the meanings indicated.. 2) Terms Defined.. a) "Family member" means, with respect to an individual, any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of the individual.
31.10.06.27.htm 31.10.06.27. 27 Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plans.. A. General Standards.. 1) The standards found in §B―D of this regulation 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, 2010.2) A policy or certificate may not be advertised, solicited, delivered, or issued for delivery in this State as a Medicare supplement policy or certif
31.10.06.28.htm 31.10.06.28. 28 Standard Medicare Supplement Benefit Plans for 2010 Plans.. A. Definitions.. 1) In this regulation, the following term has the meaning indicated.. 2) Term Defined. "Structure, language, and format" means style, arrangement, and overall content of a benefit.B. General Standards.. 1) The standards found in §C―I of this regulation are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this State with an effective date for coverage
31.10.06.29.htm 31.10.06.29. 29 Repealed..
31.10.06.30.htm 31.10.06.30. 30 Outlines of Coverage for Standardized Medicare Supplement Benefit Plans.. A. Forms.. To view this regulation, please click on the link below.. Click here to view regulation .30..
31.10.06.31.htm 31.10.06.31. 31 Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020.A. General Standards.. 1) A policy or certificate that provides coverage of the Medicare Part B deductible may not be advertised, solicited, delivered, or issued for delivery in this State as a Medicare supplement policy or certificate to individua
31.10.06.9999.htm 31.10.06.9999. Administrative History Effective date:. Regulations .01―21 adopted as an emergency provision effective July 14, 1992 (19:16 Md. R. 1466) adopted permanently effective August 3, 1992 (19:15 Md. R. 1389) ―Chapter revised effective April 1, 1996 (23:6 Md. R. 475). Regulation .14A amended, and Regulation .21 repealed, and Regulations .22 and .23 recodified to Regulations .21 and .22, respectively, as an emergency provision effective April 25, 1996 (23:10 Md. R.
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