RSA 415-F:3 · Standards for Policy Provisions and Authority to Adopt Rules

415-F:3 Standards for Policy Provisions and Authority to Adopt Rules. –

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I.

No Medicare supplement policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.

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II.

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 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 6 months before the effective date of coverage.

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III.

The commissioner shall adopt reasonable rules under RSA 541-A to establish specific standards for policy provisions of Medicare supplement policies and certificates. Such standards shall be in addition to and in accordance with applicable laws of this state. No requirement of the insurance code relating to 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:

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(a)

Terms of renewability.

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(b)

Initial and subsequent conditions of eligibility.

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(c)

Nonduplication of coverage.

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(d)

Probationary periods.

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(e)

Benefit limitations, exceptions, and reductions.

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(f)

Elimination periods.

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(g)

Requirements for replacement.

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(h)

Recurrent conditions.

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(i)

Definitions of terms.

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IV.

The commissioner may adopt reasonable rules under RSA 541-A to establish minimum standards for benefits, claims payment, marketing practices, compensation arrangements and reporting practices for Medicare supplement policies and certificates.

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V.

The commissioner may adopt rules, under RSA 541-A, as are necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated under such federal law, including but not limited to:

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(a)

Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements.

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(b)

Establishing a uniform methodology for calculating and reporting loss ratios.

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(c)

Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance.

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(d)

Establishing a process for approving or disapproving policy forms, certificate forms, and proposed premium increases.

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(e)

Establishing a policy for holding public hearings prior to approval of premium increases.

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(f)

Establishing standards for medicare select policies and certificates.

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VI.

The commissioner may adopt rules under RSA 541-A that specify prohibited policy provisions not otherwise specifically authorized by statute which, in the opinion of the commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate. Source. 1994, 233:1, eff. Jan. 1, 1995.

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