N.H. Code Admin. R. Ins 1902.06 - Minimum Standards For Medicare Supplement Policies

No policy or certificate shall be advertised, solicited, delivered, or issued for delivery in this state as a medicare supplement policy or certificate unless it meets or exceeds the following minimum standards:

(a) Medicare supplement policies and certificates, advertised, solicited, delivered, or issued for delivery in this state shall comply with the following:

(1) A medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than 6 months from the effective date of coverage because it involved a preexisting condition and shall not define a preexisting condition more restrictively than the definition found in Ins 1902.04(k);

(2) A medicare supplement policy or certificate shall not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents;

(3) 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 co-payment percentage factors. Premiums may be changed to correspond with such benefit changes, but such changes in premiums may not be implemented prior to their approval by the commissioner pursuant to RSA 415:1;

(4) A "noncancellable," "guaranteed renewable," or "noncancellable and guaranteed renewable" medicare supplement policy or certificate shall not 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) The rights of an insured with respect to or upon termination shall be as follows:

a. Except as authorized by the insurance commissioner an issuer shall neither cancel nor nonrenew a medicare supplement policy or certificate for any reason other than nonpayment of premium or material misrepresentation;

b. If a group medicare supplement insurance policy is terminated by the group policyholder and not replaced as provided in Ins 1902.06(a)(5)e., the insurer shall give written notice to certificateholders and offer an individual medicare supplement policy with at least the following choices:

1. An individual medicare supplement policy currently offered by the issuer having comparable benefits to those contained in the terminated group medicare supplement policy; and

2. An individual medicare supplement policy that provides only such benefits as are required to meet the minimum standards as defined in Ins 1902.06(b);

c. If membership in a group is terminated, the issuer shall give written notice and:

1. Offer the certificateholder such conversion opportunities as are described in Ins 1902.06(a)(5)e.; or

2. At the option of the group policyholders, offer the certificateholder continuation of coverage under the group policy;

d. The certificateholder shall have 30 days following receipt of written notice to apply for any conversion policy offered pursuant to this section;

e. If a group medicare supplement policy is replaced by another group medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination; and

f. Coverage under the replacement policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy that was replaced; and

(6) The termination of a medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be predicated upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits.

(b) Medicare supplement policies advertised, solicited, delivered, or issued for delivery in this state shall meet or exceed the following minimum benefit standards:

(1) Coverage of part A medicare eligible expenses for hospitalization to the extent not covered by medicare for the 61st day through the 90th day in any medicare benefit period;

(2) Coverage for either all or none of the medicare part A inpatient hospital deductible amount;

(3) Coverage of part A medicare eligible expenses incurred as daily hospital charges during the use of Medicare's lifetime hospital inpatient reserve days;

(4) Upon exhaustion of all medicare hospital inpatient coverage including the lifetime reserve days, coverage of 90 percent of all medicare part A eligible expenses for hospitalization not covered by medicare subject to a lifetime maximum benefit of an additional 365 days;

(5) Coverage under medicare part A for the reasonable cost of the first 3 pints of blood or equivalent quantities of packed red blood cells, as defined under 42 CFR Part 409.87 unless replaced in accordance with 42 CFR Part 409.87 or already paid for under part B;

(6) Coverage for coinsurance amount of medicare eligible expenses under part B regardless of hospital confinement subject to a maximum calendar year out-of-pocket amount equal to the $100 medicare part B deductible; and

(7) Coverage under medicare part B for the reasonable cost of the first 3 pints of blood or equivalent quantities of packed red blood cells, as defined under 42 CFR Part 409.87 unless replaced in accordance with 42 CFR Part 409.87 or already paid under part A, subject to the medicare deductible amount.

Notes

N.H. Code Admin. R. Ins 1902.06

#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5119, eff 4-25-91; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99

New. #8555, eff 2-1-06

Amended by Volume XXXVI Number 06, Filed February 11, 2016, Proposed by #11014, Effective 1/8/2016, Expires 1/8/2026.