2022 -- H 7244

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LC004310

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES

     

     Introduced By: Representatives Kennedy, Azzinaro, Potter, Edwards, Bennett,
Ackerman, Morales, Diaz, Casimiro, and Messier

     Date Introduced: January 28, 2022

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 27-18.2-1 and 27-18.2-3 of the General Laws in Chapter 27-18.2

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

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     27-18.2-1. Definitions.

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     (a) "Applicant" means:

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     (1) In the case of an individual Medicare supplement policy, the person who seeks to

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contract for insurance benefits; and

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     (2) In the case of a group Medicare supplement policy, the proposed certificate holder.

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     (b) "Certificate" means, for the purposes of this chapter, any certificate delivered or issued

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for delivery in this state under a group Medicare supplement policy.

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     (c) "Certificate form" means the form on which the certificate is delivered or issued for

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delivery by the issuer.

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     (d) "Director" means the director of the department of business regulation. or

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"Commissioner" means the commissioner for the office of the health insurance commissioner.

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     (e) "Issuer" includes insurance companies, fraternal benefit societies, health care service

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plans, health maintenance organizations, and any other entity delivering or issuing for delivery in

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this state Medicare supplement policies or certificates.

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     (f) "Medicare" means the "Health Insurance for the Aged Act," 42 U.S.C. § 1395 et seq.

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     (g) "Medicare supplement policy" means a group or individual policy of accident and

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sickness insurance, as defined in § 27-18-1, or a subscriber contract of a nonprofit hospital service

 

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corporation or of a nonprofit medical service corporation or an evidence of coverage of a health

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maintenance organization as defined in § 42-62-4(5) or as licensed under chapter 41 of this title,

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other than a policy issued pursuant to a contract under Section 1876 of the Federal Social Security

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Act, 42 U.S.C. § 1395mm, or an issued policy under a demonstration project specified in 42 U.S.C.

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§ 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to

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reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible

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for Medicare.

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     (h) "Policy form" means the form on which the policy is delivered or issued for delivery

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by the issuer.

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     27-18.2-3. Standards for policy provisions.

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

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benefits which duplicate benefits provided by Medicare.

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

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

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effective date of coverage because it involved a preexisting condition. The policy or certificate shall

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not define a preexisting condition more restrictively than a condition for which medical advice was

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given or treatment was recommended by or received from a physician within six (6) months before

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the effective date of coverage.

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

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standards for policy provisions of Medicare supplement policies and certificates. Those standards

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

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

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

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

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

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     (1) Terms of renewability;

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     (2) Initial and subsequent conditions of eligibility;

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     (3) Nonduplication of coverage;

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     (4) Probationary periods;

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     (5) Benefit limitations, exceptions, and reductions;

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     (6) Elimination periods;

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     (7) Requirements for replacement;

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     (8) Recurrent conditions; and

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     (9) Definitions of terms.

 

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

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

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commissioner, those provisions are unjust, unfair, or unfairly discriminatory to any person insured

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or proposed to be insured under a Medicare supplement policy or certificate.

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

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standards for premium rates, benefits, claims payment, marketing practices, and compensation

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arrangements and reporting practices for Medicare supplement policies and certificates.

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

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

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

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

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requirements;

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

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

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Medicare supplement insurance;

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

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and proposed premium increases;

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

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

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

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

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

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

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the age of sixty-five (65) who is eligible for Medicare due to a disability or end-stage renal disease,

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provided that the applicant submits their application during the first six (6) months immediately

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following the applicant's initial eligibility for Medicare Part B, or alternate enrollment period as

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determined by the commissioner. The issuance or coverage of any Medicare supplement policy

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pursuant to this section shall not be conditioned on the medical or health status or receipt of health

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care by the applicant; and no insurer shall perform individual medical underwriting on any

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applicant in connection with the issuance of a policy pursuant to this subsection.

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     SECTION 2. Chapter 27-18.2 of the General Laws entitled "Medicare Supplement

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18.2-3.1. Premium rate review.

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     (a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of

 

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this state unless the policy form or certificate form has been filed with and approved by the

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commissioner in accordance with filing requirements and procedures prescribed by the

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commissioner.

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     (b) The commissioner shall review the rate, rating formula, or rate manual filing and

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approve the filing, propose to the health insurance issuer how the filing can be amended and

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approved, or take such other actions separately or in combination as the commissioner deems

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appropriate and as authorized by law.

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     (c) The commissioner may approve, disapprove, or modify the rates, rating formula, or

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rating manual filed by the issuer.

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     (d) A health insurance rate, rating formula, or rate manual shall not be approved unless the

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commissioner determines that the health insurance issuer has demonstrated to the satisfaction of

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the commissioner that it is consistent with the proper conduct of the business of the issuer, and

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consistent with the interests of the public. In considering the interests of the public, the

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commissioner shall seek to ensure affordability and to minimize unreasonable disparities in access

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to coverage.

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     SECTION 3. This act shall take effect January 1, 2023.

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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

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eligible disabled individuals under the age of sixty-five (65). In addition, this act would transfer

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authority over Medicare supplement insurance policies from the director of business regulations to

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the insurance commissioner. This act would also require the insurance commissioner to create filing

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requirements and procedures for issuing a Medicare supplement insurance policy, review all policy

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forms or certificate forms that have been filed prior to issuing a policy, approve the filing or propose

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to the insurance issuer how the filing can be amended and approved, and review the rate, rating

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formula, or rate manual filing and approve, disapprove, or modify the rates, rating formula, or rating

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manual filed by the issuer.

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     This act would take effect January 1, 2023.

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