(1) Except for
permitted preexisting condition clauses as described in Rules
0780-01-58-.07(1)(a),
0780-01-58-.08(1)(a),
and
0780-01-58-.09(1)(a)
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.
(2) 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.
(3) No
Medicare supplement policy or certificate in force in the state shall contain
benefits that duplicate benefits provided by Medicare.
(4)
(a)
Subject to Rules
0780-01-58-.07(1)(d), (e), and
(g), and Rule
0780-01-58-.08(1)(d) and
(e) of this Chapter, 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.
(b) A Medicare supplement policy with
benefits for outpatient prescription drugs shall not be issued after December
31, 2005.
(c) 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:
1. 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
2. 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
Tenn. Comp. R.
& Regs.
0780-01-58-.06
Original
rule filed August 14, 1989; effective September 28, 1989. Repeal and new rule
filed November 26, 1990; effective January 10, 1991. Repeal and new rule filed
September 16, 1992; effective November 1, 1992. Amendment filed August 15,
1996; effective October 29, 1996. Public necessity rule filed September 1,
2005; effective through February 13, 2006. Public necessity rule filed
September 1, 2005; expired on February 13, 2006. On February 14, 2006, reverted
to rule in effect on August 31, 2005. Repeal and new rule filed October 13,
2006; effective December 27, 2006. Public necessity rule filed June 30, 2009;
effective through December 12, 2009. Emergency rule filed December 9, 2009;
effective through June 7, 2010. Amendment filed December 3, 2009; effective
March 3, 2010. Administrative changes made to the authority of this chapter due
to revisions in the 2016 Tennessee Code Annotated. Amendments filed November
20, 2018; effective 2/18/2019.
Authority: T.C.A. ยงยง
56-1-701; 56-2-301; 56-6-112;
56-6-124(a); 56-7-1401, et seq.; 56-7-1453; 56-7-1454; 56-7-1455; 56-7-1457;
56-7-1501, et seq.; 56-7-1503; 56-7-1504; 56-7-1505; 56-7-1507; and
56-32-118(a); Omnibus Budget Reconciliation Act of 1990,
Pub. L. No.
101-508, (1990); Genetic Information Non
Discrimination Act, Pub.
L. No. 110-233 (2008); Medicare Improvements for
Patients and Providers Act,
Pub. L. No.
110-275 (2008); and Medicare Access and CHIP
Reauthorization Act, Pub.
L. No. 114-10 (2015).
