Rhode Island 2025 Regular Session

Rhode Island House Bill H5494 Compare Versions

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

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5	5	2025 -- H 5494
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7	7	LC001358
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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
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES
16	16	Introduced By: Representatives Fogarty, Donovan, Hull, Spears, Carson, Bennett,
17	17	Dawson, Noret, Handy, and Kazarian
18	18	Date Introduced: February 13, 2025
19	19	Referred To: House Health & Human Services
20	20	(Dept. of Business Regulation/OHIC)
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Sections 27-18.2-3 and 27-18.2-3.1 of the General Laws in Chapter 27-18.2 1
24	24	entitled "Medicare Supplement Insurance Policies" are 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
42	42
43	43
44	44	LC001358 - Page 2 of 6
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
79	79
80	80
81	81	LC001358 - Page 3 of 6
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	(1) Any individual under the age of sixty-five (65) enrolled in a Medicare supplement Plan 6
88	88	A by reason of disability or end-stage renal disease pursuant to subsection (g) of this section, shall 7
89	89	receive a six (6) month open enrollment period for any policy or applicable certificate that an issuer 8
90	90	currently makes available in this state beginning on the first day of the month in which the 9
91	91	individual both attains the age of sixty-five (65) and remains enrolled in Medicare Parts A & B. 10
92	92	(h) Individuals enrolled in Medicare Parts A and B applying for a Medicare supplement 11
93	93	plan, regardless of age, shall receive guaranteed issue rights for standardized Medicare Supplement 12
94	94	Plan A during an annual enrollment period of at least one month each calendar year, as established 13
95	95	by the issuer. The issuance or coverage of any Medicare supplement policy pursuant to this section 14
96	96	shall not be conditioned on the medical or health status or receipt of health care by the applicant; 15
97	97	and no insurer shall perform individual medical underwriting in connection with the issuance of a 16
98	98	policy pursuant to this subsection; provided: 17
99	99	(1) That the applicant, having been enrolled in Medicare Part A and Part B, enrolled in a 18
100	100	Medicare Advantage plan under Medicare Part C, and remains enrolled in such a plan when the 19
101	101	Medicare supplement application is submitted. 20
102	102	An individual enrolled in a Medicare supplement policy or Medicare Advantage plan who 21
103	103	has been covered by any Medicare supplement policy(s) or Medicare Advantage plan(s) with no 22
104	104	gap in coverage greater than ninety (90) days beginning from that individual's Medicare supplement 23
105	105	open enrollment period, shall annually be afforded guaranteed issue rights for a period of at least 24
106	106	thirty (30) days beginning on the individual's birthday, for any available Medicare supplement 25
107	107	policy or applicable certificate that an issuer currently makes available in this state. 26
108	108	(1) The issuance or coverage of any Medicare supplement policy pursuant to subsection 27
109	109	(h) of this section shall not be conditioned on the medical or health status or receipt of health care 28
110	110	by the applicant and no issuer shall perform individual medical underwriting on any applicant in 29
111	111	connection with the issuance of a policy pursuant to this subsection. 30
112	112	(2) For those individuals under the age of sixty-five (65) enrolled in a Medicare Advantage 31
113	113	or Medicare supplement Plan A due to a disability, pursuant to subsection (g) of this section the 32
114	114	individual shall be afforded guaranteed issue rights for every Medicare supplement Plan A policy 33
115	115	or applicable certificate that an issuer, makes available in this state. Coverage shall be afforded 34
116	116
117	117
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119	119	pursuant to subsection (h)(1) of this section. 1
120	120	27-18.2-3.1. Premium rate review. 2
121	121	(a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of 3
122	122	this state unless the policy form or certificate form has been filed with and approved by the 4
123	123	commissioner in accordance with filing requirements and procedures prescribed by the 5
124	124	commissioner. 6
125	125	(b) The commissioner shall review the rate, rating formula, or rate manual filing and 7
126	126	approve the filing, propose to the health insurance issuer how the filing can be amended and 8
127	127	approved, or take other actions separately or in combination as the commissioner deems appropriate 9
128	128	and as authorized by law. 10
129	129	(1) For any rate filing subject to a public comment period, as determined by the 11
130	130	commissioner, the issuer shall bear the reasonable expenses of the commissioner in connection 12
131	131	with the filing including, but not limited to, any costs related to the compensation of actuaries or 13
132	132	other experts appointed by the commissioner to assist in reviewing the issuers requested rates. 14
133	133	(2) In the event the commissioner determines that a public hearing on a rate filing is 15
134	134	necessary, in addition to subsection (b)(1) of this section, the issuer shall also bear the reasonable 16
135	135	expenses associated with that public hearing, including without limitation costs relating to 17
136	136	advertisements, legal counsel, expert fees, and stenographic reporting. 18
137	137	(c) The commissioner may approve, disapprove, or modify the rates, rating formula, or 19
138	138	rating manual filed by the issuer. 20
139	139	(d) A health insurance rate, rating formula, or rate manual shall not be approved unless the 21
140	140	commissioner determines that the health insurance issuer has demonstrated to the satisfaction of 22
141	141	the commissioner that it is consistent with the proper conduct of the business of the issuer, and 23
142	142	consistent with the interests of the public. In considering the interests of the public, the 24
143	143	commissioner shall seek to ensure affordability and to minimize unreasonable disparities in access 25
144	144	to coverage. 26
145	145	(e) For Medicare supplement policies or applicable certificates to be issued on or after 27
146	146	January l, 2026, an issuer shall not utilize gender, attained-age, or issue-age as a part of its rating 28
147	147	structure or methodology. Community rating shall be the only rating methodology permitted for 29
148	148	any Medicare supplement policies or applicable certificates issued on or after January 1, 2026. 30
149	149	(1) Individuals enrolled in policies or applicable certificates with a rating structure or 31
150	150	methodology utilizing including one or more of attained-age, issue age, or gender prior to January 32
151	151	1, 2026 may keep those policies with those rating structures or may switch policies beginning on 33
152	152	January 1, 2026. 34
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155	155	LC001358 - Page 5 of 6
156	156	SECTION 2. This act shall take effect upon passage. 1
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158	158	LC001358
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161	161
162	162	LC001358 - Page 6 of 6
163	163	EXPLANATION
164	164	BY THE LEGISLATIVE COUNCIL
165	165	OF
166	166	A N A C T
167	167	RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES
168	168	***
169	169	This act would add several consumer protections to existing Medicare Supplement law. 1
170	170	This act would take effect upon passage. 2
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172	172	LC001358
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