2023 -- H 6179

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LC002612

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE – MEDICARE SUPPLEMENT INSURANCE POLICIES

     

     Introduced By: Representatives Donovan, Messier, McNamara, Kislak, Ajello,
Speakman, Carson, Fogarty, Shallcross Smith, and Potter

     Date Introduced: March 22, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 27-18.2-3 of the General Laws in Chapter 27-18.2 entitled "Medicare

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Supplement Insurance Policies" is hereby amended to read as follows:

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     27-18.2-3. Standards for policy provisions. [Effective July 1, 2023.]

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     (a) No Medicare supplement insurance policy or certificate in force in the state shall contain

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benefits that duplicate benefits provided by Medicare.

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     (b) Notwithstanding any other provision of law of this state, a Medicare supplement policy

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or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the

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effective date of coverage because it involved a preexisting condition. The policy or certificate shall

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not define a preexisting condition more restrictively than a condition for which medical advice was

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given or treatment was recommended by or received from a physician within six (6) months before

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the effective date of coverage.

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     (c) The commissioner shall adopt reasonable regulations to establish specific standards for

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policy provisions of Medicare supplement policies and certificates. Those standards shall be in

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addition to and in accordance with the applicable laws of this state, including but not limited to §§

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27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement

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of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the

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minimum standards contained in this chapter, shall apply to Medicare supplement policies and

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certificates. The standards may cover, but not be limited to:

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     (1) Terms of renewability;

 

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     (2) Initial and subsequent conditions of eligibility;

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     (3) Nonduplication of coverage;

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     (4) Probationary periods;

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     (5) Benefit limitations, exceptions, and reductions;

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     (6) Elimination periods;

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     (7) Requirements for replacement;

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     (8) Recurrent conditions; and

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     (9) Definitions of terms.

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     (d) The commissioner may adopt reasonable regulations that specify prohibited policy

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provisions not specifically authorized by statute, if, in the opinion of the commissioner, those

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provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be

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insured under a Medicare supplement policy or certificate.

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     (e) The commissioner shall adopt reasonable regulations to establish minimum standards

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for premium rates, benefits, claims payment, marketing practices, and compensation arrangements

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and reporting practices for Medicare supplement policies and certificates.

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     (f) The commissioner may adopt any reasonable regulations necessary to conform

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Medicare supplement policies and certificates to the requirements of federal law and regulations

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promulgated pursuant to federal law, including but not limited to:

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     (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio

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requirements;

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     (2) Establishing a uniform methodology for calculating and reporting loss ratios;

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     (3) Assuring public access to policies, premiums, and loss ratio information of issuers of

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Medicare supplement insurance;

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     (4) Establishing a process for approving or disapproving policy forms and certificate forms

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and proposed premium increases;

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     (5) Establishing a policy for holding public hearings prior to approval of premium increases

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that may include the applicant’s provision of notice of the proposed premium increase to all

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subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and

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     (6) Establishing standards for Medicare select policies and certificates.

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     (g) Each Medicare supplement Plan A policy or applicable certificate that an issuer

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currently, or at any time hereafter, makes available in this state shall be made available to any

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applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end-

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stage renal disease, provided that the applicant submits their application during the first six (6)

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months immediately following the applicant’s initial eligibility for Medicare Part B, or alternate

 

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enrollment period as determined by the commissioner. The issuance or coverage of any Medicare

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supplement policy pursuant to this section shall not be conditioned on the medical or health status

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or receipt of health care by the applicant; and no insurer shall perform individual medical

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underwriting on any applicant in connection with the issuance of a policy pursuant to this

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subsection.

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     (h) Medicare recipients over sixty-five (65) years of age applying for Medicare supplement

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plan shall receive guaranteed issue rights. The issuance or coverage of any Medicare supplement

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policy pursuant to this section shall not be conditioned on the medical or health status or receipt of

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health care by the applicant; and no insurer shall perform individual medical underwriting in

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connection with the issuance of a policy pursuant to this subsection.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE – MEDICARE SUPPLEMENT INSURANCE POLICIES

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     This act would provide all Medicare recipients over sixty-five (65) years of age applying

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for Medicare supplement plan guaranteed issue rights. The issuance or coverage of any Medicare

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supplement plan would not be conditioned on the medical or health status or receipt of health care

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by the applicant and no insurer shall perform individual medical underwriting in regards to issuance

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of a policy.

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     This act would take effect upon passage.

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