Three states (Massachusetts, Minnesota, and Wisconsin) are permitted by statute to have different standardized Medigap plans and are sometimes referred to in this context as the "waiver" States. There are also policies issued before the OBRA '90 requirements became applicable in 1992 (pre-standardized policies) that are still in effect.
Full Answer
What states have adopted the NAIC model law?
Does the NAIC regulate all states?
How many states have adopted the NAIC financial and health information model regulations?
Who is subject to NAIC model regulations?
What is NAIC accreditation?
How long do states have to adopt NAIC model laws?
Do states have to adopt NAIC model laws?
How many states have adopted laws on credit or regulations based largely on the National Conference of insurance Legislators model law?
What is the name of the NAIC National Association of Insurance Commissioners model legislation that most states have adopted?
What is the purpose of the NAIC model laws?
What is the NAIC Model Audit Rule compliance?
Which one of the following federal acts gave states responsibility and authority to regulate and tax the insurance industry?
What information should be presented in a new product rate filing?
Information provided in a new product rate filing should be presented in a format consistent with the requirements of the rate revision filings and annual premium rate and loss ratio filings so that consistency among filings can be checked.
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.
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.
What is the intent of Model 651?
clear intent of Model #651 is to reduce consumer confusion by simplifying the marketplace. Benefit options that may be offered have been standardized. Also, the number of form option variations for features other than benefit options (e.g., underwriting) are limited.
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.
What is the model 651?
Model #651 provides that an issuer must annually file its rates, rating schedules and experience by policy duration for approval by the states according to each state’s filing and approval requirements. This filing is required regardless of whether an issuer is seeking a rate revision.
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.
What is a medicaid supplement?
A Medicare supplemental (Medigap) policy is a health insurance policy sold by private insurance companies specifically to fill “gaps” in Original Medicare coverage. A Medigap policy typically provides coverage for some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare. Section 1882 (d) (3) (A) (i) of the Act specifies that a party may not sell a Medigap policy with knowledge that the policy duplicates health benefits which the applicant is otherwise entitled to, including from Medicaid programs that cover Medicare cost-sharing (for example, the Qualified Medicare Beneficiary Program), MA plans, and individual market plans.
When was Medicare established?
The Medicare program was established by Congress in 1965 with the enactment of title XVIII of the Social Security Act (the Act). The program provides payment for certain medical expenses for persons 65 years of age or older, certain disabled individuals, persons with end-stage renal disease (ESRD), and certain individuals exposed to environmental health hazards.
Does Medigap pay out of pocket?
Some standardized Medigap plans currently sold on the market provide first-dollar coverage for beneficiaries, which means the plan pays the Medicare deductibles, coinsurance, and copayments so that the beneficiary has no out-of-pocket costs for Medicare covered services. MACRA was enacted on April 16, 2015 ( Pub. L. 114-10 ), and beginning on January 1, 2020, it prohibits the sale of Medigap plans with first-dollar coverage to an individual who is a “newly eligible Medicare beneficiary,” which is further defined in section II.C.1. of this notice. The effect of this provision is that as of this date, a “newly eligible Medicare beneficiary” will be required to pay out-of-pocket for the Medicare Part B deductible. The Part B deductible for CY 2016 was $166.00 and for CY 2017 it is $183.00.
Who is responsible for coinsurance?
If a physician or certain other suppliers accept assignment, the beneficiary is only responsible for the coinsurance amount. When beneficiaries receive covered services from physicians or other suppliers who do not accept assignment of their Medicare claims, beneficiaries may also be responsible for some amounts in excess of the Medicare approved amount (excess charges).