31 Pa. Code § 89.781 - Filing and approval of policies and certificates and premium rates
(a)
Approval of policy or certificate. An issuer may not deliver
or issue for delivery a policy or certificate to a resident of this
Commonwealth, 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) An issuer shall file any riders or
amendments to policy or certificate forms to delete outpatient prescription
drug benefits as required by the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, the act of December 8, 2003 (Pub. L. No.
108-173 , 117 Stat. 2066), only with the
commissioner in the state in which the policy or certificate was
issued.
(c)
Filing of
rating schedule and supporting documentation. An issuer may not use or
change premium rates for a Medicare supplement policy or certificate unless the
rates, rating schedule and supporting documentation have been filed with and
approved by the Commissioner in accordance with the filing requirements and
procedures prescribed by the Commissioner.
(d)
Exceptions.
(1) Except as provided in paragraph (2), an
issuer may not file for approval more than one form of a policy or certificate
of each type for each standard Medicare supplement benefit plan.
(2) An issuer may offer, with the approval of
the Commissioner, up to three additional policy forms or certificate forms of
the same type for the same standard Medicare supplement benefit plan. These
additional forms may include one or more of the following three variations.
Forms with only these variations will be regarded as new policy forms under
each type:
(i) The inclusion of new or
innovative benefits.
(ii) The
addition of either direct response or producer marketing methods.
(iii) The addition of either guaranteed issue
or underwritten coverage.
(3) For the purpose of this section, a "type"
means an individual policy, a group policy, an individual Medicare Select
Policy or a group Medicare Select Policy.
(e)
Availability of policy
form.
(1) Except as provided in
subsection (a), an issuer shall continue to make available for purchase any
policy form or certificate form issued after July 30, 1992, that has been
approved by the Commissioner. A policy form or certificate form may not be
considered to be available for purchase, unless the issuer has actively offered
it for sale in the previous 12 months.
(i) An
issuer may discontinue the availability of a policy form or certificate form if
the issuer provides to the Commissioner in writing its decision at least 30
days prior to discontinuing the availability of the form of the policy or
certificate. After receipt of the notice by the Commissioner, the issuer may
not offer for sale the policy form or certificate form in this
Commonwealth.
(ii) An issuer that
discontinues the availability of a policy form or certificate form under
subsection (a) may not file for approval a new policy form or certificate form
of the same type for the same standard Medicare supplement benefit plan as the
discontinued form for 5 years after the issuer provides notice to the
Commissioner of the discontinuance. The period of discontinuance may be reduced
if the Commissioner determines that a shorter period is appropriate.
(2) The sale or other transfer of
Medicare supplement business to another issuer shall be considered a
discontinuance for the purposes of this section.
(3) A change in the rating structure or
methodology shall be considered a discontinuance under paragraph (1), unless
the issuer complies with the following requirements:
(i) The issuer provides an actuarial
memorandum, in a form and manner prescribed by the Commissioner, describing the
manner in which the revised rating methodology and resultant rates differ from
the existing rating methodology and existing rates.
(ii) The issuer does not subsequently put
into effect a change of rates or rating factors that would cause the percentage
differential between the discontinued and subsequent rates as described in the
actuarial memorandum to change. The Commissioner may approve a change to the
differential which is in the public interest.
(f)
Combination of forms.
(1) Except as provided in paragraph (2), the
experience of all policy forms or certificate forms of the same type in a
standard Medicare supplement benefit plan shall be combined for purposes of the
refund or credit calculation prescribed in §
89.780 (relating to loss ratio
standards and refund or credit of premium).
(2) Forms assumed under an assumption
reinsurance agreement may not be combined with the experience of other forms
for purposes of the refund or credit calculation.
Notes
The provisions of this § 89.781 amended under the
Omnibus Budget Reconciliation Act (OBRA 90) of November 15, 1990,
P. L.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.