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OAC 365:10

INSURANCE DEPARTMENT

  • (3)

    Organizations.

    • (A)

      The individual is enrolled with:

      • (i)

        An eligible organization under a contract under Section 1876 (Medicare risk or cost);

      • (ii)

        A similar organization operating under demonstration project authority, effective for periods before April 1, 1999;

      • (iii)

        An organization under an agreement under Section 1833(a)(1)(A) (health care prepayment plan); or

      • (iv)

        An organization under a Medicare Select Policy; and

    • (B)

      The enrollment ceases under the same circumstances that would permit discontinuance of an individual’s election of coverage under Section 365:10-5-

    • 129.1

      (b)(2).

  • (4)

    Medicare supplement. The individual is enrolled under a Medicare supplement

policy and the enrollment ceases because:

(A)

Of the insolvency of the issuer or bankruptcy of the nonissuer organization;

or because of other involuntary termination of coverage or enrollment under the

policy;

(B)

The issuer of the policy substantially violated a material provision of the

policy; or

(C)

The issuer, or an agent or other entity acting on the issuer’s behalf, materially

misrepresented the policy’s provisions in marketing the policy to the individual;

(5)

Termination of enrollment and subsequent enrollment.

The individual was

enrolled under a Medicare supplement policy and terminates enrollment and subsequently enrolls, for the first time, with any Medicare Advantage organization under a Medicare Advantage plan under part C of Medicare, any eligible organization under a contract under Section 1876 of the Social Security Act (Medicare risk or cost), any similar organization operating under demonstration project authority, any PACE provider under Section 1894 of the Social Security Act or a Medicare Select Policy; and an organization under an agreement under section 1833(a)(1)(A) (health care prepayment plan), or a Medicare Select policy; and the subsequent enrollment under this subparagraph is terminated by the enrollee during any period within the first twelve (12) months of such subsequent enrollment (during which the enrollee is permitted to terminate such subsequent enrollment under section 1851(e) of the federal Social Security Act); or

(6) (A) age

Medicare Advantage disenrollment. The individual, upon first becoming eligible for benefit under Part A of Medicare at 65, enrolls in a Medicare Advantage plan under part C of Medicare, or with a PACE

provider under Section 1894 of the Social Security Act, and disenrolls from the plan by not later than twelve (12) months after the effective date of enrollment.

    • (B)

      An individual, under age 65, who first becomes eligible for Medicare Part B and enrolls in a Medicare Advantage plan under part C of Medicare, and disenrolls from the plan by not later than twelve (12) months after the effective date of enrollment.

  • (7)

    Part D Benefit Enrollment. The individual enrolls in a Medicare Part D plan during

the initial enrollment period and, at the time of enrollment in Part D, was enrolled under a

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