These minimum standards, known as the NAIC Model Standards are found in the “Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Act” (NAIC Model), initially adopted by the NAIC on June 6, 1979, and revised periodically to reflect subsequent Federal legislative changes.
Full Answer
Why did the NAIC adopt model laws and regulations?
NAIC Model Laws, Regulations, Guidelines and Other Resources—Fall 2019 Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act
Who has the authority to regulate minimum benefit standards?
Aug 31, 2020 · Model Regulation To Implement The NAIC Medicare Supplement Insurance Minimum Standards Model Act. Guidance for Medicare supplement sponsors and beneficiaries. The purpose of this regulation is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies as well as to facilitate …
When did the standard Medicare supplement benefit plan come into effect?
associated with Medicare supplement standardization and filing requirements , as outlined in the Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act (#651). The Medicare Improve ment for Patients and Providers Act of 2008 (MIPPA) created a new set of standardized plans that differ from those adopted by the NAIC as a result …
What is an NAIC guideline?
A. In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.
What are Medicare Supplement policies designed for?
Medicare Supplement or Medigap policies are designed to pay your costs related to Original Medicare. Depending on the plan you choose, they could pay the Part A hospital deductible, the Part B deductible, and the 20% coinsurance that you are responsible for, as well as other out-of-pocket costs.
Which type of policy is available from private insurance companies and regulated by the federal government to supplement Medicare coverage?
Medigap policyIn Original Medicare, you generally pay some of the costs for approved services. Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private company that helps pay your share of costs.
Which type of Medicare policy requires insureds?
Medicare Select is a type of Medigap policy that requires insureds to use specific hospitals and in some cases specific doctors (except in an emergency) in order to be eligible for full benefits.
What is the free look period that applies to Medicare Supplement policies and certificates?
Medigap free-look period You have 30 days to decide if you want to keep the new Medigap policy. This is called your "free look period." The 30-day free look period starts when you get your new Medigap policy. You'll need to pay both premiums for one month.
Which policies must be guaranteed renewable?
Every individual long-term care policy must be guaranteed renewable. Guaranteed Renewable means that the insurer may not cancel your coverage unless you do not pay premiums on time.
What is Medigap quizlet?
Medicare Supplement Policy AKA Medigap. Also known as a Medigap Policy, is a health insurance policy sold by private insurance companies to fill in the coverage gaps in Original Medicare. The coverage gaps include deductibles and coinsurance requirements.
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals network providers except in emergency situations?
A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage Plan that generally provides health care coverage from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis).
Which provision concerns the insureds duty to provide the insurer with reasonable notice in the event of a loss?
Revocable. Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss? Notice of claim.
Which of the following can legally bind coverage?
Your insurance coverage can be bound one of two ways: coverage can be bound through the insurance company issuing the policy or by the verbal or written commitment (called a “binder”) of an authorized representative of the company, such as an agent.
Who regulates Medicare Supplement plans?
Medicare Supplement plans are standardized and offer various benefits to help offset your healthcare cost. The California Department of Insurance (CDI) regulates Medicare Supplement policies underwritten by licensed insurance companies.
What states are guaranteed issue for Medicare Supplement?
Only four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of medical history (Figure 1).Jul 11, 2018
What is a participating life insurance policy?
A participating policy enables you, as a policyholder, to share the profits of the insurance company. These profits are shared in the form of bonuses or dividends. It is also known as a with-profit policy. In non-participating policies, the profits are not shared and no dividends are paid to the policyholders.Sep 15, 2021
Why are Medicare rate relativities not match?
This is because premium refunds are based on claims experience by plan, so issuers need to consider this experience in developing premium rates. However, benefit relativities should be considered in determining rate relativities, particularly for plans without credible experience.
What is the age limit for Medicare Part B?
As a result of OBRA-90, Model #651 required a Medigap open enrollment period for individuals 65 years and older during the first six months of initial enrollment in Medicare Part B. SSAA-94 added a Medigap open enrollment for any individual who attains age 65 and has been receiving, or has ever received, Medicare Part B due to disability or end-stage renal disease (ESRD) prior to age 65. All plans the carrier offers for sale must be available during these open enrollment periods. Both the federal Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration have always held that an individual “attains age 65” as of the first day of the month in which the individual turns 65 unless the individual’s birthday occurs on the first day of the month, in which case the individual is deemed to be 65 as of the first day of the preceding month. In the case of an applicant whose application for a policy or certificate is submitted prior to or during the six-month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B, an issuer is prohibited from discriminating in the availability, sale or pricing of a policy because of the health status, claims experience, receipt of health care or medical condition of the applicant. For this open enrollment period to be “real,” the offered rates during the Medigap open enrollment period must be calculated by a method that is consistent with the method used for underwritten business. Consistency would not be maintained if the rate charged during Medigap open enrollment effectively discourages new entrants, or if it reflects the full load for anti-selection and individuals are allowed to “re-enter” a specific block of business after the Medigap open enrollment period ends.
When do you have to file Medicare Supplement Refund?
By May 31 of each year, each issuer must file in each state, for each refund class, the Medicare Supplement Refund Calculation Form. If a refund is indicated, the refund must be made (with interest from the end of the calendar year) before September 30 following the reporting year.
Is BBA 97 preexisting condition?
While OBRA-90 limited the use of preexisting condition exclusions to a six-month period , and eliminated their use for replacement Medicare supplement coverage, BBA-97 includes HIPAA-like language dealing with portability issues. The concept of portability is only applicable to the Medigap open enrollment period. If a beneficiary applying during Medigap open enrollment has a continuous period of prior creditable coverage that is less than six months (defined in Model #651, Section 4E and Section 4F), the carrier must credit such prior creditable coverage against the preexisting condition exclusion period. If the beneficiary has six months or more of prior creditable coverage, then a preexisting condition exclusion is not allowed.
Does Model 651 prohibit group rating?
Nothing in Model #651 explicitly prohibits group rating practices. However, it should be noted that, in 1993, the NAIC Medicare Supplement and Other Limited Benefit Plans (B) Task Force sent a letter to CMS stating, “The task force believes that the prohibition of experience rating is in the best interest of the consumer and is most consistent with NAIC models. … This interpretation is consistent with federal statutes and regulations, including OBRA-90.”
Is the relative cost by age more stable than the other factors?
The relative cost by age is also subject to differences among carriers and changes over time. However, it is likely to be somewhat more stable than the other factors. The relative cost by attained age (in five-year age groups), as may have been applicable in the 1990s for the basic kinds of Medicare supplement plans, may be found in Section VIII.
Why is it reasonable to define the policy period as the total life of the policy?
Because the policies are guaranteed renewable, it is reasonable to define this period as the total life of the policy. This does not detract from the ability to reflect reasonable assumptions for persistency, interest, medical inflation and rate revisions.