28 Tex. Admin. Code § 3.3305 - Policy Provisions
(a) Except for
permitted preexisting condition clauses described in §
3.3306(b)(1)(A)
of this title (relating to Minimum Benefit Standards), 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, contract, or certificate in force in this state may
contain benefits that duplicate benefits provided by Medicare.
(d) Subject to §
3.3306(b)(1)(D) and
(E) of this title, a Medicare supplement
policy with benefits for outpatient prescription drugs in existence before
January 1, 2006, must be renewed for current policyholders who do not enroll in
Part D at the option of the policyholder.
(e) A Medicare supplement policy with
benefits for outpatient prescription drugs may not be issued after December 31,
2005.
(f) 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
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