2025 -- H 5499
========
LC001385
========
S T A T E O F R H O D E I S L A N D
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2025
____________
A N A C T
RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES
Introduced By: Representatives Stewart, Giraldo, Furtado, Potter, Edwards, Donovan,
Morales, Fogarty, and Tanzi
Date Introduced: February 13, 2025
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Section 27-18.2-3 of the General Laws in Chapter 27-18.2 entitled "Medicare 1
Supplement Insurance Policies" is hereby amended to read as follows: 2
27-18.2-3. Standards for policy provisions. 3
(a) No Medicare supplement insurance policy or certificate in force in the state shall contain 4
benefits that duplicate benefits provided by Medicare. 5
(b) Notwithstanding any other provision of law of this state, a Medicare supplement policy 6
or certificate shall not exclude or limit benefits for loss incurred more than six (6) months from the 7
effective date of coverage because it involved a preexisting condition. The policy or certificate shall 8
not define a preexisting condition more restrictively than a condition for which medical advice was 9
given or treatment was recommended by or received from a physician within six (6) months before 10
the effective date of coverage. 11
(c) The commissioner shall adopt reasonable regulations to establish specific standards for 12
policy provisions of Medicare supplement policies and certificates. Those standards shall be in 13
addition to and in accordance with the applicable laws of this state, including but not limited to §§ 14
27-18-3(a) and 42-62-12 and regulations promulgated pursuant to those sections. No requirement 15
of this title or chapter 62 of title 42 relating to minimum required policy benefits, other than the 16
minimum standards contained in this chapter, shall apply to Medicare supplement policies and 17
certificates. The standards may cover, but not be limited to: 18
(1) Terms of renewability; 19
LC001385 - Page 2 of 4
(2) Initial and subsequent conditions of eligibility; 1
(3) Nonduplication of coverage; 2
(4) Probationary periods; 3
(5) Benefit limitations, exceptions, and reductions; 4
(6) Elimination periods; 5
(7) Requirements for replacement; 6
(8) Recurrent conditions; and 7
(9) Definitions of terms. 8
(d) The commissioner may adopt reasonable regulations that specify prohibited policy 9
provisions not specifically authorized by statute, if, in the opinion of the commissioner, those 10
provisions are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be 11
insured under a Medicare supplement policy or certificate. 12
(e) The commissioner shall adopt reasonable regulations to establish minimum standards 13
for premium rates, benefits, claims payment, marketing practices, and compensation arrangements 14
and reporting practices for Medicare supplement policies and certificates. 15
(f) The commissioner may adopt any reasonable regulations necessary to conform 16
Medicare supplement policies and certificates to the requirements of federal law and regulations 17
promulgated pursuant to federal law, including but not limited to: 18
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio 19
requirements; 20
(2) Establishing a uniform methodology for calculating and reporting loss ratios; 21
(3) Assuring public access to policies, premiums, and loss ratio information of issuers of 22
Medicare supplement insurance; 23
(4) Establishing a process for approving or disapproving policy forms and certificate forms 24
and proposed premium increases; 25
(5) Establishing a policy for holding public hearings prior to approval of premium increases 26
that may include the applicant’s provision of notice of the proposed premium increase to all 27
subscribers subject to the proposed increase, at least ten (10) days prior to the hearing; and 28
(6) Establishing standards for Medicare select policies and certificates. 29
(g) Each Medicare supplement Plan A policy or applicable certificate that an issuer 30
currently, or at any time hereafter, makes available in this state shall be made available to any 31
applicant under the age of sixty-five (65) who is eligible for Medicare due to a disability or end-32
stage renal disease, provided that the applicant submits their application during the first six (6) 33
months immediately following the applicant’s initial eligibility for Medicare Part B, or alternate 34
LC001385 - Page 3 of 4
enrollment period as determined by the commissioner. The issuance or coverage of any Medicare 1
supplement policy pursuant to this section shall not be conditioned on the medical or health status 2
or receipt of health care by the applicant; and no insurer shall perform individual medical 3
underwriting on any applicant in connection with the issuance of a policy pursuant to this 4
subsection. 5
Rhode Island residents eligible for Medicare due to age sixty-five (65) years or older or 6
due to disability or end-stage renal disease if under age sixty-five (65) years are entitled to 7
continuous enrollment rights for Medicare supplement ("Medigap") policies. Insurers are 8
prohibited from using medical underwriting or any other method to deny Medigap coverage to 9
eligible individuals who are applying under the provisions of this chapter. Premium rates for 10
Medicare supplement policies shall be determined on a community-rated basis. 11
(h) Individuals enrolled in Medicare Parts A and B applying for a Medicare supplement 12
plan, regardless of age, shall receive guaranteed issue rights for standardized Medicare Supplement 13
Plan A during an annual enrollment period of at least one month each calendar year, as established 14
by the issuer. The issuance or coverage of any Medicare supplement policy pursuant to this section 15
shall not be conditioned on the medical or health status or receipt of health care by the applicant; 16
and no insurer shall perform individual medical underwriting in connection with the issuance of a 17
policy pursuant to this subsection; provided: 18
(1) That the applicant, having been enrolled in Medicare Part A and Part B, enrolled in a 19
Medicare Advantage plan under Medicare Part C, and remains enrolled in such a plan when the 20
Medicare supplement application is submitted. 21
The office of the health insurance commissioner ("OHIC") shall conduct an annual review 22
of premium rates for Medicare supplement policies pursuant to §27-18.2-3(d). 23
(i) OHIC shall monitor compliance with the provisions of this chapter and may impose 24
administrative penalties on insurers for violations, including, but not limited to fines, suspension 25
of policy offerings, or corrective action orders. Nothing in this title 27 ("insurance") shall limit the 26
actions that may be taken by the Rhode Island attorney general under any state or federal laws. 27
(j) If any provision of this section or the application to any person or circumstance, is held 28
to be invalid, the remaining provisions of this section shall not be affected. The invalidity of any 29
part of this section shall not affect the validity of the remaining provisions. 30
SECTION 2. This act shall take effect on January 1, 2026 31
========
LC001385
========
LC001385 - Page 4 of 4
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- MEDICARE SUPPLEMENT INSURANCE POLICIES
***
This act would seek to promote increased consumer access to Medicare supplement health 1
insurance policies. 2
This act would take effect on January 1, 2026. 3
========
LC001385
========