Utah Admin. Code R590-146-11 - Open Enrollment
A. An issuer
shall not deny or condition the issuance or effectiveness of any Medicare
supplement policy or certificate available for sale in this state, nor
discriminate in the pricing of a policy or certificate because of the health
status, claims experience, receipt of health care, or medical condition of an
applicant in the case of an application for a policy or certificate that is
submitted prior to or during the six month period beginning with the first day
of the first month in which an individual is both 65 years of age or older and
is enrolled for benefits under Medicare Part B. Each Medicare supplement policy
and certificate currently available from an insurer shall be made available to
all applicants who qualify under this section without regard to age.
B.
(1) If
an applicant qualifies under Subsection A and submits an application during the
time period referenced in Subsection A and, as of the date of application, has
had a continuous period of creditable coverage of at least six months, the
issuer shall not exclude benefits based on a preexisting condition.
(2) If the applicant qualifies under
Subsection A and submits an application during the time period referenced in
Subsection A and, as of the date of application, has had a continuous period of
creditable coverage that is less than six months, the issuer shall reduce the
period of any preexisting condition exclusion by the aggregate of the period of
creditable coverage applicable to the applicant as of the enrollment date. The
Secretary shall specify the manner of the reduction under this
subsection.
C. Except as
provided in Subsection B and Sections 12 and 23, Subsection A shall not be
construed as preventing the exclusion of benefits under a policy, during the
first six months, based on a preexisting condition for which the policyholder
or certificateholder received treatment or was otherwise diagnosed during the
six months before the coverage became effective.
Notes
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