Title 38.2. Insurance
Subtitle .
Chapter 36. Medicare Supplement Policies
Chapter 36. Medicare Supplement Policies.
§ 38.2-3600. Medicare supplement policy; definition."Medicare supplement policy" means an individual or group accident and sickness insurance policy or certificate, or a health maintenance organization subscription contract or evidence of coverage, issued or issued for delivery in this Commonwealth which is (i) designed primarily to supplement Medicare by providing benefits for payment of hospital, medical or surgical expenses, or (ii) advertised, marketed or otherwise purported to be a supplement to Medicare.
For group policies, the term does not include a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or a combination of employees and labor organizations, for employees, former employees, or a combination of employees and labor organizations or for members or former members, or combination thereof, of the labor organizations.
1979, c. 726, § 38.1-362.7; 1986, c. 562; 1992, c. 225; 1996, c. 11.
Group Medicare supplement policies shall be expected to return to policyholders in the form of aggregate benefits at least seventy-five percent of the aggregate amount of premiums collected.
1981, c. 575, § 38.1-362.8:1; 1986, c. 562.
Repealed by Acts 1989, c. 151, § 2.
Medicare supplement policies sold on an individual basis shall be expected to return to policyowners in the form of aggregate benefits at least sixty-five percent of the aggregate amount of premiums collected.
1981, c. 575, § 38.1-362.8:3; 1986, c. 562; 1991, c. 120.
Notwithstanding the provisions of § 38.2-3502, Medicare supplement policies shall have printed on the policy a notice stating substantially: "RIGHT TO RETURN POLICY WITHIN THIRTY DAYS. If for any reason you are not satisfied with your policy you may return this policy to the company within thirty days of the date you received it and the premium paid will be promptly refunded."
A policy returned pursuant to the notice shall be void upon the mailing or delivery of the policy to the insurer.
Nothing in this section shall prohibit an insurer from extending the right to examine period to more than thirty days if the period is specified in the policy.
1980, c. 204, § 38.1-362.13; 1981, c. 575; 1986, c. 562; 1989, c. 151.
Notwithstanding subdivision 2 (b) of § 38.2-3503 or the provisions of § 38.2-3514.1, an insurer that issues a Medicare supplement policy shall not deny a claim for losses incurred more than six months from the effective date of coverage on the grounds that a condition existed prior to the effective date of coverage regardless of the application form used. Except as so provided, the policy or contract shall not include wording that would permit a defense based upon preexisting conditions.
1980, c. 204, § 38.1-362.15; 1981, c. 575; 1986, c. 562; 1995, c. 522.
Pursuant to the authority granted in § 38.2-223, the Commission may issue rules and regulations that may (i) require that an outline of coverage for Medicare supplement policies be delivered to the insured at the time the application is made and (ii) prescribe the format and content of the outline of coverage.
1980, c. 204, § 38.1-362.16; 1986, c. 562; 1996, c. 11.
A. The provisions of §§ 38.2-3418.1, 38.2-3604, 38.2-3605, 38.2-3606 and 38.2-3516 through 38.2-3520 shall be applicable to group Medicare supplement policies. The term "policy" as used in this article shall include a certificate issued under a group Medicare supplement policy which has been delivered or issued for delivery in this Commonwealth.
B. The provisions of § 38.2-3418.1 shall be applicable to individual Medicare supplement policies.
C. No Medicare supplement policy or certificate in force in this Commonwealth shall contain benefits that duplicate benefits provided by Medicare.
1981, c. 575, § 38.1-362.17; 1986, c. 562; 1989, c. 646; 1996, c. 11.
A. The Commission may issue regulations to establish minimum standards for payment of claims under Medicare supplement policies and for marketing practices, compensation arrangements, requirements for loss ratio refunds or credits, Medicare select policies and certificates, and reporting practices of insurers providing such policies.
B. The Commission may revise or amend such regulations and may increase the scope of the regulations only to the extent necessary to maintain federal approval of the Commonwealth's program for regulation of Medicare supplement insurance pursuant to the requirements established by the United States Department of Health and Human Services.
C. The Commission shall annually advise the standing committees of the General Assembly having jurisdiction over insurance matters of revisions and amendments made pursuant to subsection B.
1989, c. 151; 1990, c. 268; 1992, c. 225; 1996, c. 11.
Every insurer, health service plan or health maintenance organization providing Medicare supplement insurance or benefits in this Commonwealth shall file with the Commission a copy of any Medicare supplement advertisement intended for use in this Commonwealth whether through written, radio or television medium.
1989, c. 151.
A. An insurer, health services plan, or health maintenance organization issuing Medicare supplement policies or certificates in the Commonwealth, including policies or certificates issued on an individual or group basis or through a group trust, shall offer the opportunity of enrolling in at least one of its issued Medicare supplement policies or certificates to any individual who resides in the Commonwealth, is under 65 years of age, is eligible for Medicare by reason of disability, as defined by 42 U.S.C. § 426(b) or 42 U.S.C. § 426-1, and is enrolled in Medicare Part A and B, or will be so enrolled by the effective date of coverage. Such Medicare supplement policies or certificates shall be issued on a guaranteed renewable basis under which the insurer shall be required to continue coverage as long as premiums are paid on the policy or certificate. Such Medicare supplement policies or certificates shall be offered:
1. Upon the request of the individual during the six-month period beginning with the first month in which the individual is eligible for Medicare by reason of a disability. For those persons who are retroactively enrolled in Medicare Part B due to a retroactive eligibility decision made by the Social Security Administration, the application must be submitted within a six-month period beginning with the month in which the person receives notification of the retroactive eligibility decision; or
2. Upon the request of the individual during the 63-day period following voluntary or involuntary termination of coverage under a group health plan.
B. The six-month period to enroll in a Medicare supplement policy or certificate for an individual who is under 65 years of age and is eligible for Medicare by reason of disability under 42 U.S.C. § 426(b) and otherwise eligible under subsection A and first enrolled in Medicare Part B before January 1, 2021, shall begin on January 1, 2021. The six-month period to enroll in a Medicare supplement policy or certificate for an individual who is under 65 years of age and is eligible for Medicare by reason of disability under 42 U.S.C. § 426-1 and otherwise eligible under subsection A and first enrolled in Medicare Part B before January 1, 2024, shall begin on January 1, 2024.
C. A Medicare supplement policy or certificate issued to an individual under subsection A shall not exclude benefits based on a preexisting condition if the individual has a continuous period of creditable coverage of at least six months as of the effective date of coverage.
D. Effective January 1, 2024, an insurer shall not charge individuals who become eligible for Medicare by reason of disability and who are under 65 years of age premium rates for any Medicare supplement policy or certificate offered by the issuer that exceed the premium rates charged for such plan to individuals who are 65 years of age.
E. For purposes of this section, "creditable coverage" and "group health plan" have the same meanings ascribed to the terms in § 38.2-3431.
A. An insurer, health services plan, or health maintenance organization issuing individual Medicare supplement policies or certificates in the Commonwealth, including policies or certificates issued on an individual basis through a non-employer group trust, plan, or association, shall offer to an individual currently insured under any such policy or certificate an annual open enrollment period commencing on the day of the individual's birthday and remaining open for at least 60 days thereafter, during which time the individual may purchase any Medicare supplement policy made available by any insurer in the Commonwealth that offers the same benefits as those provided by the current coverage. Innovative benefits, as described in 42 U.S.C. § 1395ss(p)(4)(B), shall not be considered when determining whether a Medicare supplement policy includes the same benefits as those provided by the previous coverage.
B. During the annual open enrollment period offered pursuant to this section, no insurer, health services plan, or health maintenance organization shall deny or condition the issuance or effectiveness, or discriminate in the price of coverage, of a Medicare supplement policy based on the health status, claims history, receipt of health care, or medical condition of an individual currently insured under any such policy.
C. At least 15 days but not more than 30 days prior to the commencement of an annual open enrollment period for an individual to whom the open enrollment period established by the provisions of this section applies, the insurer, health services plan, or health maintenance organization issuing a Medicare supplement policy or certificate shall notify each such individual of:
1. The dates on which the open enrollment period begins and ends;
2. The rights of the individual during the open enrollment period; and
3. Any modification of the benefits provided by the policy under which the individual is currently insured or adjustment of the premiums charged for that policy.
D. As used in this section, "Medicare supplement policy" includes policies offered by public entities that otherwise meet the requirements of this chapter.