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OAC 365:10

INSURANCE DEPARTMENT

equivalent to coverage in effect before the date of such suspension. If the suspended Medicare supplement policy provided coverage for outpatient prescription drugs, reinstitution of the policy for Medicare Part D enrollees shall be without coverage for outpatient prescription drugs and shall otherwise provide substantially equivalent coverage to the 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

certificateholder

as

the

premium

(8)

If

an

classification terms that would have applied to the certificateholder had the coverage not been suspended. issuer makes a written offer to the Medicare Supplement

policyholder

or

policyholders

or

certificateholders of one or more of its plans, to exchange during a specified period from his or her 1990 Standardized plan as described in O.A.C. 365:10-5-127 to a 2010 Standardized plan as described in O.A.C. 365:10-5-127.1, the offer and subsequent exchange shall comply

with

the

following

requirements:

(A)

An issuer need not provide justification to the Commissioner if the insured

replaces a 1990 Standardized policy or certificate with an issue age rated 2010 Standardized policy or certificate at the insured’s original issue age and duration. If an insured’s policy or certificate to be replaced is priced on an issue age rate schedule at the time of such offer, the rate charged to the insured for the new exchanged policy shall recognize the policy reserve buildup, due to the pre-funding inherent in the use of an issue age rate basis, for the benefit of the insured. The method proposed to be used by an issuer must be filed with the commissioner according to the state’s rate filing procedure. (B) The rating class of the new policy or certificate shall be the class closest to the insured’s class of the replaced coverage. (C) An issuer may not apply new pre-existing condition limitations or a new incontestability period to the new policy for those benefits contained in the exchanged 1990 Standardized policy or certificate of the insured, but may apply pre- existing condition limitations of no more than six (6) months to any added benefits contained in the new 2010 Standardized policy or certificate not contained in the exchanged policy. (D) The new policy or certificate shall be offered to all policyholders or certificateholders within a given plan, except where the offer or issue would be in

violation of state or federal law.

(c)

Standards for basic ("Core") benefits common to Benefit Plans A-J. Every issuer shall

make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic "core" package, but not in lieu

(1)

Coverage of Part A Medicare Eligible Expenses for hospitalization to the extent not

covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(2)

Coverage of Part A Medicare Eligible Expenses incurred for hospitalization to the

thereof.

extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

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