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OAC 365:10


minimum standards. These are minimum standards and do not preclude the inclusion of other provisions or benefits which are not inconsistent with these standards. (b) General standards. The following standards apply to Medicare supplement policies and certificates and are in addition to all other requirements of this Part. (1) 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 shall 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) A Medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents. (3) 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 percentage factors. Premiums may be modified to correspond with such changes. (4) A "noncancellable," "guaranteed renewable," or "noncancellable and guaranteed renewable" Medicare supplement policy shall not:

    • (A)

      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; or

    • (B)

      Be cancelled or nonrenewed by the issuer solely on the grounds of deterioration of health.

  • (5)

    Except as authorized by the Commissioner of this state, an issuer shall neither cancel nor

nonrenew a Medicare supplement policy or certificate for any reason other than nonpayment of premium or material misrepresentation. (A) If a group Medicare supplement insurance policy is terminated by the group policyholder and not replaced as provided in (b)(5)(C) of this section, the issuer shall offer certificateholders an individual Medicare supplement policy. The issuer shall offer the certificateholder at least the following choices:

    • (i)

      An individual Medicare supplement policy currently offered by the issuer having comparable benefits to those contained in the terminated group Medicare supplement policy; or

    • (ii)

      An individual Medicare supplement policy which provides only such benefits as are required to meet the minimum standards as defined in 365:10- 5-127(c).

  • (B)

    If membership in a group is terminated, the issuer shall:

    • (i)

      Offer the certificateholder such conversion opportunities as are described in (b)(5)(A) of this section; or

    • (ii)

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

  • (C)

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

supplement policy purchased by the same policyholder, the succeeding issuer shall offer coverage to all persons covered under the old group policy on its date of

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