House Bill #5210 (2021)

AN ACT RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES

Requires that Medicare supplement policies be made available to Medicare eligible disabled individuals under the age of sixty-five (65).

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Changes since original draft

  • 2021 – H 5210
  • 2021 – H 5210 SUBSTITUTE A
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  • LC000374
  • LC000374/SUB A
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  • S TATE OF RHODE IS LAND
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • ____________
  • A N A C T
  • RELATING TO INSURANCE – MEDICARE SUPPLEMENT INSURANCE POLICIES
  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • ____________
  • A N A C T
  • RELATING TO INSURANCE – MEDICARE SUPPLEMENT INSURANCE POLICIES
  • Introduced By: Representatives Kennedy, Azzinaro, Bennett, Diaz, and Potter
  • Date Introduced: January 27, 2021
  • Referred To: House Finance
  • It is enacted by the GeneralAssembly as follows:
  • SECTION1. Section 27-18.2-3 of the General Lawsin Chapter27-18.2 entitled "Medicare Supplement Insurance Policies" is hereby amended to read as follows:
  • 27-18.2-3. Standards for policy provisions.
  • (a)NoMedicaresupplement insurance policy or certificatein forcein the stateshallcontain benefits which duplicate benefits provided by Medicare.
  • (b) Notwithstanding anyother provision of law of this state,a Medicare supplement policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the effectivedate of coveragebecauseitinvolved a preexisting condition. Thepolicy or certificate shall not define a preexisting condition more restrictively thana condition for which medical advice was given or treatmentwas recommendedby or received from a physician within six (6) months before the effective date of coverage.
  • (c)The director shall adopt reasonable regulations to establish specific standardsfor policy provisions of Medicare supplement policies and certificates. Those standards shall be in addition to and in accordance with the applicable laws of this state,including but not limited to §§ 27-18- 3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement of this title or chapter 62of title 42 relating tominimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The standards may cover, but not be limited to:
  • (1) Terms of renewability;
  • It is enacted by the General Assembly as follows:
  • SECTION 1. Sections 27-18.2-1 and 27-18.2-3 of the General Laws in Chapter 27-18.2 entitled "Medicare Supplement Insurance Policies" are hereby amended to read as follows:
  • 27-18.2-1. Definitions.
  • (a) "Applicant" means:
  • (1) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and
  • (2) In the case of a group Medicare supplement policy, the proposed certificate holder.
  • (b) "Certificate" means, for the purposes of this chapter, any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.
  • (c) "Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer.
  • (d) "Director" means the director of the department of business regulation. or "Commissioner" means the commissioner for the office of the health insurance commissioner.
  • (e) "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.
  • (f) "Medicare" means the "Health Insurance for the Aged Act," 42 U.S.C. § 1395 et seq.
  • (g) "Medicare supplement policy" means a group or individual policy of accident and sickness insurance, as defined in § 27-18-1, or a subscriber contract of a nonprofit hospital service corporation or of a nonprofit medical service corporation or an evidence of coverage of a health maintenance organization as defined in § 42-62-4(5) or as licensed under chapter 41 of this title, other than a policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act, 42 U.S.C. § 1395mm, or an issued policy under a demonstration project specified in 42 U.S.C. § 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.
  • (h) "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer.
  • 27-18.2-3. Standards for policy provisions.
  • (a)NoMedicaresupplementinsurancepolicyorcertificateinforceinthestateshallcontain benefits which duplicate benefits provided by Medicare.
  • (b) Notwithstanding any other provision of law of this state, a Medicare supplement policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the effectivedateofcoveragebecauseit involvedapreexistingcondition.Thepolicyorcertificateshall 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.
  • (c) The director commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies and certificates. Those standards shall be in addition to and in accordance with the applicable laws of this state, including but not limited to §§ 27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement of this title or chapter 62 of title 42 relatingto minimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The standards may cover, but not be limited to:
  • (1) Terms of renewability;
  • (2) Initial and subsequent conditions of eligibility;
  • (3) Nonduplication of coverage;
  • (4) Probationary periods;
  • (5) Benefit limitations, exceptions, and reductions;
  • (6) Elimination periods;
  • (7) Requirements for replacement;
  • (8) Recurrent conditions; and
  • (9) Definitions of terms.
  • (d) The director mayadopt reasonable regulations thatspecify prohibited policy provisions not specifically authorized by statute,if, in the opinion of the director, those provisions are unjust, unfair, or unfairly discriminatory to anypersoninsured or proposed to be insured under a Medicare supplement policy or certificate.
  • (e) The director shall adopt reasonable regulations to establish minimum standards for benefits, claims payment, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.
  • (f) The director may adopt any reasonable regulations necessary to conform Medicare supplement policies and certificatesto the requirements of federallaw andregulations promulgated pursuant to federallaw, including but not limited to:
  • (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
  • (2) Establishing a uniform methodology for calculating and reporting loss ratios;
  • (3) Assuring public access topolicies, premiums, and loss ratio information of issuers of Medicare supplement insurance;
  • (4) Establishing a processfor approving or disapproving policy forms andcertificate forms and proposed premium increases;
  • (5) Establishing a policy for holding public hearings prior toapproval of premium increases which may include the applicant's provision of notice of the proposed premium increase to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and
  • (6) Establishing standards for Medicare select policies and certificates.
  • (g) Each Medicare supplement policy or applicable certificate that an issuer currently, or at any time hereafter,makes available in this state shall be made available to any applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability, including, without limitation, end-stage renaldisease, provided that the applicant submits their application during the first six (6) months immediately following the applicant's enrollment in Medicare Part B. The
  • LC000374 - Page 2of 4 issuance or coverage of any Medicare supplement policy pursuant to this section shall not be conditioned on, nor shall the price of the policy be discriminatory basedupon the medical or health status or receipt of health care by the applicant; and no insurer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this section.
  • SECTION 2. This act shalltake effect upon passage. ======== LC000374 ========
  • LC000374 - Page 3of 4
  • (d) The director commissioner may adopt reasonable regulations that specify prohibited policy provisions not specifically authorized by statute, if, in the opinion of the director commission, those provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.
  • (e) The director commissioner shall adopt reasonable regulations to establish minimum standards for premium rates, benefits, claims payment, marketing practices, and compensation arrangements and reporting practices for Medicare supplement policies and certificates.
  • (f) The director commissioner may adopt any reasonable regulations necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated pursuant to federal law, including but not limited to:
  • (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
  • (2) Establishing a uniform methodology for calculating and reporting loss ratios;
  • (3) Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance;
  • (4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
  • (5)Establishingapolicyforholdingpublichearingsprior toapprovalofpremiumincreases which may include the applicant's provision of notice of the proposed premium increase to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and
  • (6) Establishing standards for Medicare select policies and certificates.
  • (g) Each Medicare supplement policy or applicable certificate that an issuer currently, or at any time hereafter, makes available in this state shall be made available to any applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end-stage renal disease, provided that the applicant submits their application during the first six (6) months immediately following the applicant's initial eligibility for Medicare Part B, or alternate enrollment period as determined by the commissioner. The issuance or coverage of any Medicare supplement policy pursuant to this section shall not be conditioned on the medical or health status or receipt of health care by the applicant; and no insurer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this paragraph.
  • SECTION 2. Chapter 27-18.2 of the General Laws entitled "Medicare Supplement Insurance Policies" is hereby amended by adding thereto the following section:
  • 27-18.2-12. Premium rate review.
  • (a) 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) The commissioner shall review the rate, rating formula, or rate manual filing and approve the filing, propose to the health insurance issuer how the filing can be amended and approved, or take such other actions separately or in combination as the commissioner deems appropriate and as authorized by law.
  • (c) The commissioner may approve, disapprove, or modify the rates, rating formula, or rating manual filed by the issuer.
  • (d) A health insurance rate, rating formula, or rate manual shall not be approved unless the commissioner determines that the health insurance issuer has demonstrated to the satisfaction of the commissioner that it is consistent with the proper conduct of the business of the issuer, and consistent with the interests of the public. In considering the interests of the public, the commissioner shall seek to ensure affordability and to minimize unreasonable disparities in access to coverage.
  • SECTION 4. This act shall take effect January 1, 2022.
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  • LC000374/SUB A
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  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T
  • RELATING TO INSURANCE – MEDICARE SUPPLEMENT INSURANCE POLICIES
  • A N A C T
  • RELATING TO INSURANCE – MEDICARE SUPPLEMENT INSURANCE POLICIES
  • ***
  • This act would require that Medicare supplement policies be made available to Medicare eligible disabled individuals under the age of sixty-five (65).
  • This act would take effect upon passage. ======== LC000374 ========
  • LC000374 - Page 4of 4
  • This act would take effect January 1, 2022. ======== LC000374/SUB A ========

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