Section 3218. Medicare supplemental insurance policies  


Latest version.
  • (a) In this section:
        (1) "Medicare"  means the coverage of health care costs provided under
      subchapter XVIII of the federal Social Security Act, 42 U.S.C.  §§  1395
      et seq.
        (2) "Medicare  supplemental  insurance"  means any individual or group
      accident and health policy issued for delivery in this state on or after
      June tenth, nineteen  hundred  eighty,  providing  for  the  payment  or
      reimbursement  for health care services not provided by medicare, except
      that such  terms  shall  not  include  a  contract  issued  pursuant  to
      subsections (c) and (d) of section four thousand two hundred thirty-five
      or section four thousand three hundred five of this chapter which covers
      employees  of firms doing business in more than one state or the benefit
      structure of which was the subject of  collective  bargaining  affecting
      employees of firms doing business in more than one state.
        (b) The superintendent shall promulgate rules and regulations which:
        (1)  Establish  as  a  separate  classification, medicare supplemental
      insurance.
        (2) Provide for minimum standards for medicare supplemental  insurance
      policies.
        (3)  Require  the ratio of benefits to premiums to be not less than an
      appropriate percentage determined by the  superintendent  and  requiring
      the   annual   filing  of  data  that  will  demonstrate  the  insurer's
      compliance.
        (4) Provide a uniform system of designation for  said  policies  which
      indicates the type and scope of coverage afforded.
        (5)  Provide  for  full disclosure of coverage in a clear and coherent
      manner using words with common everyday language.
        (6) Prohibit the advertisement, sale, or solicitation of any  accident
      or  health  insurance  policy as being supplemental to medicare coverage
      unless it  conforms  to  minimum  standards  for  medicare  supplemental
      insurance policies provided by this section.
        (7)  Provide  for  the  publication  and dissemination of a consumer's
      shopping guide for medicare supplemental insurance.
        (c) No authorized insurer shall issue or deliver  in  this  state  any
      medicare   supplemental   insurance   policy   other   than  a  medicare
      supplemental insurance policy which includes the  minimum  standards  as
      approved by the superintendent.
        (d)  (1)  Every  authorized insurer engaged in issuing for delivery in
      this state, policies for medicare supplemental insurance as set forth in
      this section shall file with the superintendent a report of  all  claims
      experience  for such coverage for each twelve month period preceding the
      dates fixed by the superintendent for the filing of such reports.   Such
      reports  shall  be  made  in  writing  and  on  a form prescribed by the
      superintendent not  less  than  annually  on  dates  determined  by  the
      superintendent.
        (2)  The  provisions  of  this  subsection shall remain in force until
      December thirty-first, nineteen hundred eighty-three.