law25434

Chapter 434

2025 -- H 5494 SUBSTITUTE A
Enacted 07/02/2025

A N A C T

RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES

Introduced By: Representatives Fogarty, Donovan, Hull, Spears, Carson, Bennett, Dawson, Noret, Handy, and Kazarian

Date Introduced: February 13, 2025

It is enacted by the General Assembly as follows:

SECTION 1. Sections 27-18.2-3 and 27-18.2-3.1 of the General Laws in Chapter 27-18.2

entitled "Medicare Supplement Insurance Policies" are 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 that 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.

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 commissioner may adopt reasonable regulations that specify prohibited policy

provisions not specifically authorized by statute, if, in the opinion of the commissioner, 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 commissioner shall adopt reasonable regulations to establish minimum standards

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

and reporting practices for Medicare supplement policies and certificates.

(f) The commissioner 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

that 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 Plan A 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 or end-

stage renal disease, provided that the applicant submits their application during the first six (6)

months immediately following the applicant’s initial eligibility for Medicare Part B, or alternate

enrollment period as determined by the commissioner. The issuance or coverage of any Medicare

supplement policy pursuant to this section shall not be conditioned on 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

subsection.

(1) Any individual under the age of sixty-five (65) enrolled in a Medicare supplement Plan

A by reason of disability or end-stage renal disease pursuant to subsection (g) of this section, shall

receive a six-(6)month (6) open enrollment period for any policy or applicable certificate that an

issuer currently makes available in this state beginning on the first day of the month in which the

individual both attains the age of sixty-five (65) and remains enrolled in Medicare Parts A & B.

(h) Individuals enrolled in Medicare Parts A and B applying for a Medicare supplement

plan, regardless of age, shall receive guaranteed issue rights for standardized Medicare Supplement

Plan A during an annual enrollment period of at least one month each calendar year, as established

by the issuer. The issuance or coverage of any Medicare supplement policy pursuant to this section

shall not be conditioned on the medical or health status or receipt of health care by the applicant;

and no insurer shall perform individual medical underwriting in connection with the issuance of a

policy pursuant to this subsection; provided:

(1) That the applicant, having been enrolled in Medicare Part A and Part B, enrolled in a

Medicare Advantage plan under Medicare Part C, and remains enrolled in such a plan when the

Medicare supplement application is submitted.

Each year, for the duration of the Medicare Annual Enrollment Period (AEP) for coverage

with an effective date of January 1 of the following year, an individual enrolled in a Medicare

supplement policy or Medicare Advantage plan who has been covered by any Medicare supplement

policy(s) or Medicare Advantage plan(s) with no gap in coverage greater than ninety (90) days

beginning from that individual's Medicare Initial Enrollment Period (IEP), shall be afforded

guaranteed issue rights for any available Medicare supplement policy or applicable certificate that

an issuer currently makes available in this state.

(1) The issuance or coverage of any Medicare supplement policy pursuant to subsection

(h) of this section shall not be conditioned on the medical or health status or receipt of health care

by the applicant and no issuer shall perform individual medical underwriting on any applicant in

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

(2) For those individuals under the age of sixty-five (65) enrolled in a Medicare Advantage

or Medicare supplement Plan A due to a disability, pursuant to subsection (g) of this section the

individual shall be afforded guaranteed issue rights for every Medicare supplement Plan A policy

or applicable certificate that an issuer, makes available in this state. Coverage shall be afforded

pursuant to subsection (h)(1) of this section.

27-18.2-3.1. Premium rate review.

(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

commissioner.

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

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

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

and as authorized by law.

(1) For any rate filing subject to a public comment period, as determined by the

commissioner, the issuer shall bear the reasonable expenses of the commissioner in connection

with the filing including, but not limited to, any costs related to the compensation of actuaries or

other experts appointed by the commissioner to assist in reviewing the issuers requested rates.

(2) In the event the commissioner determines that a public hearing on a rate filing is

necessary, in addition to subsection (b)(1) of this section, the issuer shall also bear the reasonable

expenses associated with that public hearing, including without limitation costs relating to

advertisements, legal counsel, expert fees, and stenographic reporting.

rating manual filed by the issuer.

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

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

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

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

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

to coverage.

(e) The office of the health insurance commissioner shall evaluate the impact of adopting

a community rating structure for Medicare supplement plans and certificates. The commissioner

shall further review the notification process for enrollment periods, frequency, and outreach by the

insurer. On or before January 1, 2026, the office shall report to the general assembly on its findings

and recommendations.

SECTION 2. This act shall take effect upon passage.

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LC001358/SUB A

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