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OAC 365:10

INSURANCE DEPARTMENT

365:10-5-132. Filing and approval of policies and certificates and premium rates (a) Policy forms and certificates filing and approval requirements. An issuer shall not deliver or issue for delivery a 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 the Commissioner. (b) Removal of Prescription Drug benefit. An issuer shall file any rider or amendments to policy and certificate forms to delete outpatient prescription drug benefits as required by the Medicare Prescription Drug, improvement, and Modernization Act of 2003 only with the commissioner in the state in which the policy or certificate was issued. (c) Premium rates and rating schedule filing and approval requirements. An issuer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been filed with and approved by the Commissioner in accordance with the filing requirements and procedures prescribed by the Commissioner.

  • (d)

    Additional policy or certificate forms.

    • (1)

      Except as provided in paragraph (2) of this subsection, an issuer shall not file for approval more than one form of a policy or certificate of each type for each standard Medicare supplement benefit plan.

    • (2)

      An issuer may offer, with the approval of the Commissioner, up to four (4) additional policy forms or certificate forms of the same type for the same standard Medicare supplement benefit plan, one for each of the following cases:

      • (A)

        The inclusion of new or innovative benefits;

      • (B)

        The addition of either direct response or agent marketing methods;

      • (C)

        The addition of either guaranteed issue or underwritten coverage;

      • (D)

        The offering of coverage to individuals eligible for Medicare by reason of disability.

    • (3)

      For the purposes of this section, a "type" means an individual policy, a group policy, an individual Medicare Select policy, or a group Medicare Select policy.

  • (e)

    Policy forms and certificate forms availability for purchase after Commissioner's

approval. (1) Except as provided in (A) of this paragraph, an issuer shall continue to make available for purchase any policy form or certificate form issued after the effective date of this Part that has been approved by the Commissioner. A policy form or certificate form shall not be considered to be available for purchase unless the issuer has actively offered it for sale in the previous twelve (12) months. (A) An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the Commissioner in writing its decision at least thirty (30) days prior to discontinuing the availability of the form of the policy or certificate. After receipt of the notice by the Commissioner, the issuer shall no longer offer for sale the policy form or certificate form in this state. (B) An issuer that discontinues the availability of a policy form or certificate form pursuant to (A) of this paragraph shall not file for approval a new policy form or certificate form of the same type for the same standard Medicare supplement benefit plan as the discontinued form for a period of five (5) years after the issuer provides

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