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OAC 365:10

INSURANCE DEPARTMENT

(6)

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 policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced. Continuous loss. 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 conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part

D benefits will not be considered in determining a continuous loss.

(7)

Suspension.

(A)

A Medicare supplement policy or certificate shall provide that benefits and

premiums under the policy or certificate shall be suspended at the request of the

policyholder or certificateholder for the period (not to exceed twenty-four (24) months) in which the policyholder or certificateholder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificateholder notifies the issuer of the policy or certificate within ninety (90) days after the date the individual becomes entitled to assistance. (B) If suspension occurs and if the policyholder or certificateholder loses entitlement to medical assistance, the policy or certificate shall be automatically reinstituted (effective as of the date of termination of entitlement) as of the termination of entitlement if the policyholder or certificateholder provides notice of loss of entitlement within ninety (90) days after the date of loss and pays the premium attributable to the period, effective as of the date of termination of entitlement. (C) Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits

under Section 226 plan (as defined

(b) of the Social Security Act and is covered under a group health in Section 1862 (b)(1)(A)(v) of the Social Security Act). If

suspension

occurs

and

if

the

policyholder

or

certificate

holder

loses

coverage

under

the the

group health plan, the policy shall be automatically reinstituted (effective as of date of loss of coverage) if the policyholder provides notice of loss of coverage

within ninety (90) days after the date of the loss.

  • (D)

    Reinstitution of coverages as described in Subparagraphs (B) and (C):

    • (i)

      Shall not provide for any waiting period with respect to treatment of preexisting conditions;

    • (ii)

      Shall provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension; and

    • (iii)

      Shall provide for classification of premiums on terms at least as

favorable to classification

the policyholder or certificateholder as the premium terms that would have applied to the policyholder or

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