| 47 | | - | SECTION 1. The legislature finds that existing state law requires insurance companies that sell medicare supplement insurance, also known as medigap insurance, to issue medigap insurance on a guaranteed-issue basis to eligible individuals without adjusting premiums based on medical underwriting, as long as their applications are submitted within the open enrollment period. Under current rules, this open enrollment period in the State is during the six-month window that begins when the individual is enrolled for benefits under medicare part B. After this open enrollment period, there is no guarantee that the insurance companies will issue medigap insurance to individuals with preexisting medical conditions unless the individual satisfies certain conditions, and even if issued, the premium may be significantly higher. Therefore, it is extremely difficult for individuals whose health conditions or financial situations may have changed after their open enrollment period to switch to another medigap benefit plan that is more suitable. The purpose of this Act is to: (1) Require the insurance commissioner to establish an annual open enrollment for applicants and require issuers of medigap insurance in the State to accept an individual's application for coverage or an enrollee's application to switch to another eligible plan during that period; and (2) Prohibit issuers from denying the applicant a medigap policy or certificate or make any premium rate distinctions because of health status, claims experience, medical condition, or whether the applicant is receiving health care services. SECTION 2. Section 431:10A-304, Hawaii Revised Statutes, is amended to read as follows: "§431:10A-304 Standards for policy provisions. (a) No medicare supplement policy or certificate in force in the State shall contain benefits that duplicate benefits provided by medicare. (b) The commissioner shall adopt reasonable rules to establish specific standards for the provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this State, including the provisions of part I of this article. No requirement of this chapter relating to minimum required policy benefits, other than the minimum standards contained in this part, 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 reasonable rules that specify prohibited policy provisions not otherwise specifically authorized by law, which, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under any medicare supplement policy or certificate. (d) A medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months after the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage. (e) The insurance commissioner shall adopt rules to establish an annual open enrollment period for beneficiaries who have been enrolled in a medicare supplemental policy for a minimum of twelve months. Applicants shall be accepted during the open enrollment period for any medicare supplement insurance benefit plan available from an issuer. (f) No issuer of medicare supplement insurance policies or certificates in the State shall deny or condition the issuance or effectiveness of any medicare supplement policy or certificate available for sale in the State, or discriminate in the pricing of the policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant. The requirements of this subsection shall be applicable to applicants enrolled for benefits under medicare part B, whether by reason of age or by reason of disability." SECTION 3. The insurance commissioner shall amend or adopt rules consistent with the requirements of this Act. SECTION 4. New statutory material is underscored. SECTION 5. This Act shall take effect on December 31, 3000. |
|---|
| 47 | + | SECTION 1. The legislature finds that existing state law requires insurance companies that sell medicare supplement insurance, also known as medigap insurance, to issue medigap insurance on a guaranteed-issue basis to eligible individuals without adjusting premiums based on medical underwriting, as long as their applications are submitted within the open enrollment period. Under existing rules, this open enrollment period in the State is during the six-month window that begins when the individual is enrolled for benefits under medicare part B. After this open enrollment period, there is no guarantee that the insurance companies will issue medigap insurance to individuals with preexisting medical conditions unless the individual satisfies certain conditions, and even if issued, the premium may be significantly higher. Therefore, it is extremely difficult for individuals whose health conditions or financial situations may have changed after their open enrollment period to switch to another medigap benefit plan that is more suitable. The purpose of this Act is to require issuers of medigap insurance in the State to accept an individual's application for coverage or an enrollee's application to switch to another eligible plan at any time throughout the year, and prohibit issuers from denying the applicant a medigap policy or certificate or make any premium rate distinctions because of health status, claims experience, medical condition, or whether the applicant is receiving health care services. SECTION 2. Section 431:10A-304, Hawaii Revised Statutes, is amended to read as follows: "§431:10A-304 Standards for policy provisions. (a) No medicare supplement policy or certificate in force in the State shall contain benefits that duplicate benefits provided by medicare. (b) The commissioner shall adopt reasonable rules to establish specific standards for the provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this State, including the provisions of part I of this article. No requirement of this chapter relating to minimum required policy benefits, other than the minimum standards contained in this part, 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 reasonable rules that specify prohibited policy provisions not otherwise specifically authorized by law, which, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under any medicare supplement policy or certificate. (d) A medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months after the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage. (e) No issuer of medicare supplement insurance policies or certificates in the State shall deny or condition the issuance or effectiveness of any medicare supplement policy or certificate available for sale in the State, nor discriminate in the pricing of the policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant. Applicants shall be accepted at all times throughout the year for any medicare supplement insurance benefit plan available from an issuer. The requirements of this subsection shall be applicable to applicants enrolled for benefits under medicare part B, whether by reason of age or by reason of disability." SECTION 3. The insurance commissioner shall amend or adopt rules consistent with the requirements of this Act. SECTION 4. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable. SECTION 5. New statutory material is underscored. SECTION 6. This Act shall take effect on December 31, 2050. |
|---|