Full Answer
What are the sections of a pre-standardized Medicare supplement benefit plan policy?
Section 1. Purpose Section 2. Authority Section 3. Applicability and Scope Section 4. Definitions Section 5. Policy Definitions and Terms Section 6. Policy Provisions Section 7. Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to July 1, 1992 Section 8.
Who is the issuer of a Medicare supplement policy or certificate?
“Issuer of a Medicare supplement policy or certificate” includes a third-party administrator, or other person acting for or on behalf of such issuer. “Family member” means, with respect to an individual, any other individual who is a first-degree, second-degree, third degree, or fourth-degree relative of such individual.
What do you need to know about multiple Medicare Supplement policies?
Section 22. Reporting of Multiple Policies A. On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate: (1) Policy and certificate number, and (2) Date of issuance. B.
When to not use the terms “Medicare Supplement” and “Medigap”?
The terms “Medicare Supplement,” “Medigap,” “Medicare Wrap-Around” and words of similar import shall not be used unless the policy is issued in compliance with this regulation. Section 21. Appropriateness of Recommended Purchase and Excessive Insurance A.
Who standardized Medicare supplement?
The California Department of Insurance (CDI)The California Department of Insurance (CDI) regulates Medicare Supplement policies underwritten by licensed insurance companies.
Which of the following is a requirement for standard Medicare supplement plans?
What are those requirements? People must be at least 65 years old, regardless of their health condition, and must apply for a Medicare supplement policy within six months of enrolling in Medicare Part B.
Which entities has been authorized by Congress to standardize Medicare supplement policies?
Centers for Medicare & Medicaid Services (CMS), HHS.
What is the minimum guaranteed issue period for a Medicare supplement insurance policy?
People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F. You can/must apply for a Medigap policy: No later than 63 calendar days from the date your coverage ends. There may be times when more than one of the situations above applies to you.
What group drafted the model act that standardized Medigap?
Legislation established minimum Federal standards for Medigap policies by adopting model standards developed by the National Association of Insurance Commissioners (NAIC).
Which of the following must be included in a Medicare Supplement policies outline of coverage?
All Medicare supplement policies must provide certain core benefits, including coverage for Medicare Part A-eligible hospital expenses not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period, the coinsurance amount of Medicare Part B-eligible expenses, and coverage under Medicare ...
When did Medicare supplement plans became standardized?
1997The trend began in 1997, when Congress authorized the Medicare Select plans, which limit supplemental coverage to providers in the plan's network.
Which renewal provision must all Medicare supplement policies contain quizlet?
A continuation provision must include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the policy holders age.
Which renewal provision must all Medicare supplement policies contain?
A Medicare Supplement Policy must contain a 30-day Free Look Provision on the first page of the policy in bold print.
Who files Medicare Supplement claims?
Your Medicare Part A and B claims are submitted directly to Medicare by your providers (doctors, hospitals, labs, suppliers, etc.). Medicare takes approximately 30 days to process each claim.
Which states have non standardized Medicare Supplement plans?
Medigap plans are standardized across most states, meaning they offer the same benefits. The exceptions are Wisconsin, Minnesota and Massachusetts.
Which of the following is true about Medicare Supplement insurance plans?
Which of the following is true about Medicare Supplement Insurance Plans? They are regulated by the Centers for Medicare & Medicaid Services (CMS). Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments.
Who accepts the Medicare Model Regulation?
The Model Regulation was accepted by the Centers for Medicare and Medicaid Services (CMS), as it is the agency that administers Medicare. The proposed amendment to §3.3306 (1) (G) (ii) requires Medicare supplement policies and certificates to include provisions that allow benefits and premiums to be suspended for any period ...
What are the Texas amendments to 3.3306?
The Texas Department of Insurance proposes amendments to §§3.3306, 3.3308 and 3.3312 concerning minimum benefit standards for issuers of Medicare supplement policies and guaranteed issuance of Medicare supplement policies to eligible beneficiaries. The amendments are necessary to implement changes made to the Social Security Act (Act) by Medicare, ...
What is the purpose of Article 3.74?
Article 3.74, §3 mandates the department to issue reasonable rules to establish minimum standards for benefits and claim payments under Medicare supplement policies . Article 3.74, §5 (b) requires the department to prescribe the format and content of the disclosure which outlines Medicare supplement policy coverage.
What is the definition of Article 3.74?
Article 3.74, §§2 (f) and 5 (f) mandate that the rules shall be at least equal to those required by federal law, regulations, and standards adopted under 42 U.S.C. §1395ss. Article 3.74, §10 provides that the department shall adopt rules in accordance with the federal law applicable to the regulation of Medicare supplement insurance coverage ...
When did the MMA stop resale of Medicare Supplement?
After December 31, 2005 , the MMA prohibits issuers of Medicare supplement policies from renewing outpatient prescription drug benefits for both prestandardized and standardized Medicare supplement policyholders who enroll in Medicare Part D. Section 3.3303 revises definitions to conform to the MMA, as does §3.3304.
What is 1652.051?
Section 1652.051 provides that the department's rules must include requirements that are at least equal to those required by federal law, rules, and standards, including 42 U.S.C. §1395ss.