Rhode Island 2025 Regular Session

Rhode Island House Bill H5431 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- H 5431
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7	7	LC001462
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
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13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES
16	16	Introduced By: Representatives Donovan, Speakman, Phillips, McNamara, Serpa,
17	17	Fellela, Edwards, Lima, Casimiro, and Potter
18	18	Date Introduced: February 12, 2025
19	19	Referred To: House Health & Human Services
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22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Section 27-18.2-3 of the General Laws in Chapter 27-18.2 entitled "Medicare 1
24	24	Supplement Insurance Policies" is hereby amended to read as follows: 2
25	25	27-18.2-3. Standards for policy provisions. 3
26	26	(a) No Medicare supplement insurance policy or certificate in force in the state shall contain 4
27	27	benefits that duplicate benefits provided by Medicare. 5
28	28	(b) Notwithstanding any other provision of law of this state, a Medicare supplement policy 6
29	29	or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the 7
30	30	effective date of coverage because it involved a preexisting condition. The policy or certificate shall 8
31	31	not define a preexisting condition more restrictively than a condition for which medical advice was 9
32	32	given or treatment was recommended by or received from a physician within six (6) months before 10
33	33	the effective date of coverage. 11
34	34	(c) The commissioner shall adopt reasonable regulations to establish specific standards for 12
35	35	policy provisions of Medicare supplement policies and certificates. Those standards shall be in 13
36	36	addition to and in accordance with the applicable laws of this state, including but not limited to §§ 14
37	37	27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement 15
38	38	of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the 16
39	39	minimum standards contained in this chapter, shall apply to Medicare supplement policies and 17
40	40	certificates. The standards may cover, but not be limited to: 18
41	41	(1) Terms of renewability; 19
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45	45	(2) Initial and subsequent conditions of eligibility; 1
46	46	(3) Nonduplication of coverage; 2
47	47	(4) Probationary periods; 3
48	48	(5) Benefit limitations, exceptions, and reductions; 4
49	49	(6) Elimination periods; 5
50	50	(7) Requirements for replacement; 6
51	51	(8) Recurrent conditions; and 7
52	52	(9) Definitions of terms. 8
53	53	(d) The commissioner may adopt reasonable regulations that specify prohibited policy 9
54	54	provisions not specifically authorized by statute, if, in the opinion of the commissioner, those 10
55	55	provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be 11
56	56	insured under a Medicare supplement policy or certificate. 12
57	57	(e) The commissioner shall adopt reasonable regulations to establish minimum standards 13
58	58	for premium rates, benefits, claims payment, marketing practices, and compensation arrangements 14
59	59	and reporting practices for Medicare supplement policies and certificates. 15
60	60	(f) The commissioner may adopt any reasonable regulations necessary to conform 16
61	61	Medicare supplement policies and certificates to the requirements of federal law and regulations 17
62	62	promulgated pursuant to federal law, including but not limited to: 18
63	63	(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio 19
64	64	requirements; 20
65	65	(2) Establishing a uniform methodology for calculating and reporting loss ratios; 21
66	66	(3) Assuring public access to policies, premiums, and loss ratio information of issuers of 22
67	67	Medicare supplement insurance; 23
68	68	(4) Establishing a process for approving or disapproving policy forms and certificate forms 24
69	69	and proposed premium increases; 25
70	70	(5) Establishing a policy for holding public hearings prior to approval of premium increases 26
71	71	that may include the applicant’s provision of notice of the proposed premium increase to all 27
72	72	subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and 28
73	73	(6) Establishing standards for Medicare select policies and certificates. 29
74	74	(g) Each Medicare supplement Plan A policy or applicable certificate that an issuer 30
75	75	currently, or at any time hereafter, makes available in this state shall be made available to any 31
76	76	applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end-32
77	77	stage renal disease, provided that the applicant submits their application during the first six (6) 33
78	78	months immediately following the applicant’s initial eligibility for Medicare Part B, or alternate 34
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82	82	enrollment period as determined by the commissioner. The issuance or coverage of any Medicare 1
83	83	supplement policy pursuant to this section shall not be conditioned on the medical or health status 2
84	84	or receipt of health care by the applicant; and no insurer shall perform individual medical 3
85	85	underwriting on any applicant in connection with the issuance of a policy pursuant to this 4
86	86	subsection. 5
87	87	(h) Individuals under the age of sixty-five (65) enrolled in Medicare Parts A and B applying 6
88	88	for a Medicare supplement plan, regardless of age, shall receive guaranteed issue rights for any 7
89	89	standardized Medicare Supplement Plan A during an annual enrollment period of for at least one 8
90	90	month each calendar year, as established by the issuer office of the health insurance commissioner. 9
91	91	The issuance or coverage of any Medicare supplement policy pursuant to this section shall not be 10
92	92	conditioned on the medical or health status or receipt of health care by the applicant; and no insurer 11
93	93	shall perform individual medical underwriting in connection with the issuance of a policy pursuant 12
94	94	to this subsection; provided: 13
95	95	(1) That the applicant, having been enrolled in Medicare Part A and Part B, enrolled in a 14
96	96	Medicare Advantage plan under Medicare Part C, and remains enrolled in such a plan when the 15
97	97	Medicare supplement application is submitted. 16
98	98	(i) Medicare recipients over sixty-five (65) years of age applying for any Medicare 17
99	99	supplement plan shall receive guaranteed issue rights for at least one month each calendar year as 18
100	100	established by the office of the health insurance commissioner. 19
101	101	(j) The issuance or coverage of any Medicare supplement policy pursuant to subsections 20
102	102	(h) and (i) of this section shall not be conditioned on the medical or health status or receipt of 21
103	103	healthcare by the applicant and no insurer shall perform individual medical underwriting in 22
104	104	connection with the issuance of a policy pursuant to this subsection; provided that, the applicant, 23
105	105	having been enrolled in Medicare Part A and Part B, enrolled in a Medicare Advantage plan under 24
106	106	Medicare Part C, and remains enrolled in such a plan when the Medicare supplement application 25
107	107	is submitted. 26
108	108	SECTION 2. This act shall take effect upon passage. 27
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115	115	EXPLANATION
116	116	BY THE LEGISLATIVE COUNCIL
117	117	OF
118	118	A N A C T
119	119	RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES
120	120	***
121	121	This act would provide that individuals under age sixty-five (65) enrolled in Medicare Parts 1
122	122	A and B would have a guaranteed right to enrollment in any standardized plan that provides 2
123	123	supplement coverage to Plan A, if enrolled during the month-long period designated by the office 3
124	124	of the health insurance commissioner (OHIC). This act would also provide that individuals over 4
125	125	age sixty-five (65) would have a guaranteed right to enroll in any Medicare supplement plan during 5
126	126	the month-long period designated by the office of the health insurance commissioner (OHIC). 6
127	127	This act would take effect upon passage. 7
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