2025 -- H 5431

========

LC001462

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

____________

A N   A C T

RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES

     Introduced By: Representatives Donovan, Speakman, Phillips, McNamara, Serpa,
Fellela, Edwards, Lima, Casimiro, and Potter

     Date Introduced: February 12, 2025

     Referred To: House Health & Human Services

     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 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.

     (c) The commissioner 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 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

LC001462 - Page 2 of 4

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.

     (h) Individuals under the age of sixty-five (65) enrolled in Medicare Parts A and B applying

for a Medicare supplement plan, regardless of age, shall receive guaranteed issue rights for any

standardized Medicare Supplement Plan A during an annual enrollment period of for at least one

month each calendar year, as established by the issuer office of the health insurance 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 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.

     (i) Medicare recipients over sixty-five (65) years of age applying for any Medicare

supplement plan shall receive guaranteed issue rights for at least one month each calendar year as

established by the office of the health insurance commissioner.

     (j) The issuance or coverage of any Medicare supplement policy pursuant to subsections

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

healthcare by the applicant and no insurer shall perform individual medical underwriting in

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

     SECTION 2. This act shall take effect upon passage.

========

LC001462

========

LC001462 - Page 3 of 4

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES

***

     This act would provide that individuals under age sixty-five (65) enrolled in Medicare Parts

A and B would have a guaranteed right to enrollment in any standardized plan that provides

supplement coverage to Plan A, if enrolled during the month-long period designated by the office

of the health insurance commissioner (OHIC). This act would also provide that individuals over

age sixty-five (65) would have a guaranteed right to enroll in any Medicare supplement plan during

the month-long period designated by the office of the health insurance commissioner (OHIC).

     This act would take effect upon passage.

========

LC001462

========

LC001462 - Page 4 of 4