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OAC 365:10

INSURANCE DEPARTMENT

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 before June 1, 2010 remain subject to the requirements of O.A.C. 365:10-5-126 and 365:10-5-127.

(b)

General Standards. The following standards apply to Medicare supplement policies and

certificates and are in addition to all other requirements of this regulation.

(1)

Preexisting conditions.

A Medicare supplement policy or certificate shall not

exclude or limit benefits for losses incurred more than six (6) months 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 six (6) months before the effective date of coverage. (2) Sickness and accidents. A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents. (3) Benefits designed to cover cost sharing amounts under Medicare. 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 amount and copayment factors. Premiums may be modified to correspond with such changes. (4) Termination of coverage of a spouse. 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.

(5)

Guaranteed renewable

. Each Medicare supplement policy shall be guaranteed

renewable. (A)

The issuer shall not cancel or nonrenew the policy solely on the ground of

health status of the individual.

(B)

The issuer shall not cancel or nonrenew 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 O.A.C. 365:10-5-127.1(b)(5)(E) of this

regulation, the issuer shall offer certificateholders an individual supplement policy which (at the option of the certificateholder):

Medicare

(i)

Provides for continuation of the benefits contained in the group

policy; or

(ii)

Provides for benefits that otherwise meet the requirements of this

(D)

Subsection. If an individual is a certificateholder in a group Medicare supplement policy

and the individual terminates membership in the group, the issuer shall

    • (i)

      Offer the certificateholder the conversion opportunity described in Section 8.1A(5)(c) of this regulation; or

    • (ii)

      At the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy.

  • (E)

    If a group Medicare supplement policy is replaced by another group Medicare

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