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OAC 365:10

INSURANCE DEPARTMENT

policies or certificates delivered or issued for delivery in this state on or after July 1, 1992 and prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit 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)

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 cast 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 percentage 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 and

(A)

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

health status of the individual; and

(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 (b)(5)(E) of this section, the issuer shall offer certificateholders an individual Medicare supplement policy which at the option of

the certificateholder:

    • (i)

      provides for continuation of the benefits contained in the group policy, or

    • (ii)

      provides for such benefits as otherwise meets the requirements of this subsection.

  • (D)

    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

  • (b)

    (5)(C) of this section, or

    • (ii)

      at the option of the group policyholder, offer the certificateholder

continuation of coverage under the group policy.

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