2021 -- H 5210

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LC000374

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES

     Introduced By: Representatives Kennedy, Azzinaro, Bennett, Diaz, and Potter

     Date Introduced: January 27, 2021

     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 require 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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