Haw. Code R. § 16-12-5 - Policy provisions
(a) Except for
permitted preexisting condition clauses as described in paragraphs
16-12-5.4(b)(1),
16-12-5.5(b)(1),
and
16-12-5.6(b)(1)
of this chapter, no policy or certificate may be advertised, solicited or
issued for delivery in this State as a Medicare supplement policy if the policy
or certificate contains limitations or exclusions on coverage that are more
restrictive than those of Medicare.
(b) No Medicare supplement policy or
certificate may use waivers to exclude, limit, or reduce coverage or benefits
for specifically named or described preexisting diseases or physical
conditions.
(c) No Medicare
supplement policy or certificate in force in this State shall contain benefits
which duplicate benefits provided by Medicare.
(d)
(1)
Subject to paragraphs
16-12-5.4(b)(4),
16-12-5.4(b)(5),
16-12-5.4(b)(7),
16-12-5.5(b)(4),
and
16-12-5.5(b)(5),
a Medicare supplement policy with benefits for outpatient prescription drugs in
existence prior to January 1, 2006, shall be renewed for current policyholders
who do not enroll in Part D at the option of the policyholder.
(2) A Medicare supplement policy with
benefits for outpatient prescription drugs shall not be issued after December
31, 2005.
(3) After December 31,
2005, a Medicare supplement policy with benefits for outpatient prescription
drugs may not be renewed after the policyholder enrolls in Medicare Part D
unless:
(A) The policy is modified to
eliminate outpatient prescription coverage for expenses of outpatient
prescription drugs incurred after the effective date of the individual's
coverage under a Part D plan; and
(B) Premiums are adjusted to reflect the
elimination of outpatient prescription drug coverage at the time of Medicare
Part D enrollment, accounting for any claims paid, if applicable.
Notes
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