Standards for policy provisions and authority to promulgate regulations

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  • (a) No Medicare supplement insurance policy, contract or certificate in force in the Territory shall contain benefits that duplicate benefits provided by Medicare.

  • (b) The Commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies, and certificates, which shall be in addition to and in accordance with applicable laws of this Territory. No requirement of this title relating to minimum required policy benefits, other than the minimum standards contained in this chapter, shall apply to Medicare supplement policies and certificates. The Standards may cover, but shall not be limited to:

    • (1) Terms of renewability;

    • (2) Initial and subsequent conditions of eligibility;

    • (3) Nonduplication of coverage;

    • (4) Probationary periods;

    • (5) Benefit limitations, exceptions and reductions;

    • (6) Elimination periods;

    • (7) Requirements for replacement;

    • (8) Recurrent conditions; and

    • (9) Definition of terms

  • (c) The Commissioner may adopt from time to time, such reasonable regulations as are necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations promulgated thereunder, including but not limited to:

    • (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;

    • (2) Establishing a uniform methodology for calculating and reporting loss ratios;

    • (3) Assuring public access to policies, premiums and loss ratio information of issuers of Medicare supplement insurance;

    • (4) Establishing a process for approving or disapproving policy forms and certificate form and proposed premium increases;

    • (5) Establishing a policy for holding public hearings prior to approval of premium increases; and

    • (6) Establishing standards for Medicare Select policies and certificates.


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