2019 -- H 5384

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE - MEDICARE SUPPLEMENT INSURANCE POLICIES

     Introduced By: Representatives Kennedy, Shekarchi, Ucci, Azzinaro, and Marshall

     Date Introduced: February 14, 2019

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18.2-3 of the General Laws in Chapter 27-18.2 entitled

"Medicare Supplement Insurance Policies" is hereby amended to read as follows:

     27-18.2-3. Standards for policy provisions.

     (a) No Medicare supplement insurance policy or certificate in force in the state shall

contain benefits which duplicate benefits provided by Medicare.

     (b) Notwithstanding any other provision of law of this state, a Medicare supplement

policy or certificate shall not exclude or limit benefits for loss incurred more than six (6) months

from the effective date of coverage because it involved a preexisting condition. The policy or

certificate shall not define a preexisting condition more restrictively than a condition for which

medical advice was given or treatment was recommended by or received from a physician within

six (6) months before the effective date of coverage.

     (c) The director shall adopt reasonable regulations to establish specific standards for

policy provisions of Medicare supplement policies and certificates. Those standards shall be in

addition to and in accordance with the applicable laws of this state, including but not limited to §§

27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement

of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the

minimum standards contained in this chapter, shall apply to Medicare supplement policies and

certificates. The standards may cover, but not be limited to:

     (1) Terms of renewability;

     (2) Initial and subsequent conditions of eligibility;

     (3) Nonduplication of coverage;

     (4) Probationary periods;

     (5) Benefit limitations, exceptions, and reductions;

     (6) Elimination periods;

     (7) Requirements for replacement;

     (8) Recurrent conditions; and

     (9) Definitions of terms.

     (d) The director may adopt reasonable regulations that specify prohibited policy

provisions not specifically authorized by statute, if, in the opinion of the director, those provisions

are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured

under a Medicare supplement policy or certificate.

     (e) The director shall adopt reasonable regulations to establish minimum standards for

benefits, claims payment, marketing practices, and compensation arrangements and reporting

practices for Medicare supplement policies and certificates.

     (f) The director may adopt any reasonable regulations necessary to conform Medicare

supplement policies and certificates to the requirements of federal law and regulations

promulgated pursuant to federal law, including but not limited to:

     (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio

requirements;

     (2) Establishing a uniform methodology for calculating and reporting loss ratios;

     (3) Assuring public access to policies, premiums, and loss ratio information of issuers of

Medicare supplement insurance;

     (4) Establishing a process for approving or disapproving policy forms and certificate

forms and proposed premium increases;

     (5) Establishing a policy for holding public hearings prior to approval of premium

increases which may include the applicant's provision of notice of the proposed premium increase

to all subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and

     (6) Establishing standards for Medicare select policies and certificates.

     (g) Each Medicare supplement policy or applicable certificate that an issuer currently, or

at any time hereafter, makes available in this state shall be made available to any applicant under

the age of sixty-five (65) who is eligible for Medicare due to a disability, including, without

limitation, end-stage renal disease, provided that the applicant submits their application during the

first six (6) months immediately following the applicant's enrollment in Medicare Part B. The

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issuance or coverage of any Medicare supplement policy pursuant to this section shall not be

conditioned on, nor shall the price of the policy be discriminatory based upon the medical or

health status or receipt of health care by the applicant; and no insurer shall perform individual

medical underwriting on any applicant in connection with the issuance of a policy pursuant to this

section.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - MEDICARE SUPPLEMENT INSURANCE POLICIES

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     This act would provide that Medicare supplement policies be made available to Medicare

eligible disabled individuals under the age of sixty-five (65).

     This act would take effect upon passage.

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