Section R20-6-1101. Incorporation by Reference and Modifications

A.      The Department incorporates by reference the Model Regula- tion to Implement the National Association of Insurance Com- missioners (NAIC) Medicare Supplement Insurance Minimum Standards Model Act, October 2008 (Model Regulation), and no future editions or amendments, which is on file with the Department of Insurance, 2910 N. 44th St., Phoenix, AZ 85018 and available from the National Association of Insur- ance Commissioners, Publications Department, 2301 McGee St., Suite 800, Kansas City, MO 64108.

B.       The Model Regulation is modified as follows:

1.        In addition to the terms defined in the Model Regulation, the following definitions apply:

a.         “Agent” means an insurance producer as defined in A.R.S. § 20-281(5).

b.        “Commissioner” means the Director of the Arizona Department of Insurance.

c.         “HMO” and “health maintenance organization” mean a health care services organization as defined in A.R.S. § 20-1051(7).

d.        “Regulation” means Article.

2.        Section 8A(7)(c) reads:

c. Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be sus- pended (for any period that may be provided by fed- eral regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan (as defined in Section 1862(b)(1)(A)(v) of the Social Security Act). If sus- pension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effec- tive as of the date of loss of coverage) if the policy- holder provides notice of loss of coverage within 90 days after the date of the loss of the group health plan and pays the premium attributable to the sup- plemental policy period, effective as of the date of termination of enrollment in the group health plan.

3.        Section 8.1 is revised to insert the citation to A.R.S. § 20- 1133 as follows:

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for

delivery in this state on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. No issuer may offer any [1990 Standardized Medicare supplement benefit plan] for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued before June 1, 2010 remain subject to the requirements of A.R.S. § 20- 1133.

4.        Section 8.1(A)(7)(c) is revised to read as follows:

Each Medicare supplement policy shall provide that ben- efits and premiums under the policy shall be suspended (for any period that may be provided by federal regula- tion) at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan (as defined in Section 186(b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or cer- tificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder pro- vides notice of loss of coverage within 90 days after the date of the loss and pays the premium attributable to the period, effective as of the date of termination of enroll- ment in the group health plan.

5.        Section 9.1 is revised to insert the citation to A.R.S. § 20- 1133 as follows:

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued before June 1, 2010 remain subject to the requirements of

A.R.S. § 20-1133.

6.        Subsection G of Section 15 is revised as follows:

G. An insurer shall not file or request approval of a rate structure for its Medicare supplement policies or certificates based upon attained-age rating as a struc- ture or methodology.

7.        Tables for PLAN F or HIGH DEDUCTIBLE PLAN F are revised as follows:

a.         For the table entitled “PARTS A & B” a column heading is revised from “AFTER YOU PAY $[2000] DEDUCTIBLE,** PLAN PAYS” to “[AFTER YOU PAY $[2000] DEDUCTIBLE,**] PLAN PAYS.”

b.        For the table entitled “PARTS A & B” a column heading   is   revised   from    “IN   ADDITION   TO

$[2000] DEDUCTIBLE,** YOU PAY” to [“IN ADDITION TO $[2000] DEDUCTIBLE,**] YOU PAY.”

c.         For the table entitled “OTHER BENEFITS - NOT COVERED BY MEDICARE” a column heading is revised from “AFTER YOU PAY $[2000] DEDUCTIBLE,** PLAN PAYS” to “[AFTER YOU PAY $[2000] DEDUCTIBLE,**] PLAN PAYS.”

d.        For the table entitled “OTHER BENEFITS - NOT COVERED BY MEDICARE” a column heading is revised from “IN ADDITION TO $[2000]] DEDUCTIBLE,** YOU PAY” to [“IN ADDITION TO $[2000] DEDUCTIBLE,**] YOU PAY.”

8.        Section 23 is revised as follows:

A.      If a Medicare supplement policy or certificate replaces another Medicare supplement policy or cer- tificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary peri- ods in the new Medicare supplement policy or certif- icate to the extent such time was spent under the original policy.

B.       If a Medicare supplement policy or certificate replaces another Medicare supplement policy or cer- tificate which has been in effect for at least six months, the replacing policy shall not provide any time period applicable to preexisting conditions, waiting periods, elimination periods and probation- ary periods.

Historical Note

Emergency rule adopted effective December 18, 1991, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 91-4). Emergency rule adopted again effective March 17, 1992, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 92-1). Adopted effective May 28, 1992 (Supp. 92-2). R20-6-1101 recodified from R4-14- 1101 (Supp. 95-1). Amended effective August 16, 1996 (Supp. 96-3). Amended by final rulemaking at 8 A.A.R. 2454, effective May 13, 2002 (Supp. 02-2). Section repealed; new Section made by final rulemaking at 11

A.A.R. 3671, effective November 12, 2005 (Supp. 05-3). Amended by final rulemaking at 15 A.A.R. 996, effective

June 2, 2009 (Supp. 09-2).