28 Tex. Admin. Code § 3.3322 - Filing and Approval of Policies, Certificates and Premium Rates; Discontinuance of Forms
(a) An issuer shall not
deliver or issue for delivery a policy or certificate to a resident of this
state 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 Insurance Code and applicable
regulations.
(b) An issuer shall
file any riders or amendments to policy or certificate forms to delete
outpatient prescription drug benefits as required by the MMA only with the
commissioner in the state in which the policy or certificate was
issued.
(c) An issuer shall 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 Insurance Code and this subchapter.
(d) Except as provided in paragraphs (1) -
(4) of this subsection, an issuer shall not file for approval more than one
form of a policy or certificate of each type for each standard Medicare
supplement benefit plan. For the purposes of this section, a "type" means an
individual policy, a group policy, an individual Medicare Select policy, or a
group Medicare Select policy. An issuer may offer, with the approval of the
commissioner, up to four policy forms or certificate forms of the same type for
the same standard Medicare supplement benefit plan, one for each of the
following cases:
(1) the inclusion of new or
innovative benefits;
(2) the
addition of either direct response or agent marketing methods;
(3) the addition of either guaranteed issue
or underwritten coverage; and
(4)
the offering of coverage to individuals eligible for Medicare by reason of
disability.
(e) Except
as provided in paragraph (1) of this subsection, an issuer shall continue to
make available for purchase any policy form or certificate form issued after
the effective date of this regulation that has been approved by the
commissioner. A policy form or certificate form shall not be considered to be
available for purchase unless the issuer has actively offered it for sale in
the previous 12 months.
(1) 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 shall no longer offer for
sale the policy form or certificate form in this state.
(2) An issuer that discontinues the
availability of a policy form or certificate form pursuant to paragraph (1) of
this subsection shall 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 a period of five 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.
(f) The
sale or other transfer of Medicare supplement business to another issuer shall
be considered a discontinuance for the purposes of this subsection.
(g) A change in the rating structure or
methodology shall be considered a discontinuance under subsection (e)(1) of
this section, unless the issuer complies with the following requirements:
(1) 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.
(2) 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.
(h) 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 §
3.3307 of this title (relating to
Loss Ratio Standards and Refund or Credit of Premiums), except that forms
assumed under an assumption reinsurance agreement shall not be combined with
the experience of other forms for purposes of the refund or credit
calculation.
Notes
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.