ARTICLE 3.5. Additional Requirements for Medicare Supplement Contracts

Article 3.5 repealed and added by Stats. 2000, Ch. 706, Sec. 2.

§§ 1358.1–1358.24 · 30 sections

§ 1358.1 Every health care service plan that offers any contract that primarily or solely supplements Medicare or that is advertised or represented as a supplement to…
§ 1358.2 The purpose of this article is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement…
§ 1358.3 (a) Except as otherwise provided in this section or in Sections 1358.7, 1358.12, 1358.13, 1358.16, and 1358.21, this article shall apply to all group and…
§ 1358.4 The following definitions apply for the purposes of this article: (a) “Applicant” means: (1) An individual enrollee who seeks to contract for health coverage,…
§ 1358.5 (a) A contract shall not be advertised, solicited, or issued for delivery as a Medicare supplement contract unless the contract contains definitions or terms…
§ 1358.6 (a) (1) Except for permitted preexisting condition clauses as described in Sections 1358.7, 1358.8, and 1358.81, a contract shall not be advertised, solicited,…
§ 1358.7 A contract shall not be advertised, solicited, or issued for delivery as a Medicare supplement contract prior to January 1, 2001, unless it meets or exceeds…
§ 1358.8 The following standards are applicable to all Medicare supplement contracts advertised, solicited, or issued for delivery on or after January 1, 2001, and with…
§ 1358.81 The following standards are applicable to all Medicare supplement contracts delivered or issued for delivery in this state with an effective date on or after…
§ 1358.9 The following standards are applicable to all Medicare supplement contracts delivered or issued for delivery in this state on or after July 21, 1992, and with…
§ 1358.91 The following standards are applicable to all Medicare supplement contracts delivered or issued for delivery in this state with an effective date on or after…
§ 1358.92 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly…
§ 1358.10 (a) (1) This section shall apply to Medicare Select contracts, as defined in this section. (2) A contract shall not be advertised as a Medicare Select contract…
§ 1358.11 (a) (1) An issuer shall not deny or condition the offering or effectiveness of any Medicare supplement contract available for sale in this state, nor…
§ 1358.12 (a) (1) With respect to the guaranteed issue of a Medicare supplement contract, eligible persons are those individuals described in subdivision (b) who seek to…
§ 1358.13 (a) An issuer shall comply with Section 1882(c)(3) of the federal Social Security Act (as enacted by Section 4081(b)(2)(C) of the federal Omnibus Budget…
§ 1358.14 (a) (1) (A) With respect to loss ratio standards, a Medicare supplement contract shall not be advertised, solicited, or issued for delivery unless the contract…
§ 1358.145 (a) The calculation of actual or expected loss ratios shall be pursuant to the formula in subdivision (a) of Section 1358.14, and pursuant to definitions,…
§ 1358.146 The following format shall be used for reporting loss ratio experience: MEDICARE SUPPLEMENT HEALTH CARE SERVICE PLAN CONTRACT EXPERIENCE EXHIBIT For the year…
§ 1358.15 (a) An issuer shall not advertise, solicit, or issue for delivery a Medicare supplement contract to a resident of this state unless the contract has been filed…
§ 1358.16 (a) An issuer or other entity may provide a commission or other compensation to a solicitor or other representative for the sale of a Medicare supplement…
§ 1358.17 (a) (1) Medicare supplement contracts shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent…
§ 1358.18 In the interest of full and fair disclosure, and to ensure the availability of necessary consumer information to potential subscribers or enrollees not…
§ 1358.19 An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio, or television medium to…
§ 1358.20 (a) An issuer, directly or through solicitors or other representatives, shall do each of the following: (1) Establish marketing procedures to ensure that any…
§ 1358.21 (a) In recommending the purchase or replacement of any Medicare supplement coverage, an issuer or its representative shall make reasonable efforts to determine…
§ 1358.22 (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…
§ 1358.225 (a) Every issuer shall, by June 30 of each year, file with the director a list of its Medicare supplement contracts offered or issued or outstanding in this…
§ 1358.23 (a) If a Medicare supplement contract replaces another Medicare supplement policy or certificate, or contract, the replacing issuer shall waive any time…
§ 1358.24 This section applies to all contracts that become effective on or after May 21, 2009. (a) In addition to the requirements set forth under Sections 1365.5 and…