D.C. Mun. Regs. tit. 26, r. 26-A2205

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 26-A2205 - POLICY PROVISIONS

2205.1

Except for permitted preexisting condition clauses as described in subsection 2206.4, 2207.4, and 2207 a.4 of this chapter, no policy or certificate may be advertised, solicited, or issued for delivery in the District as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.

2205.2

No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

2205.3

No Medicare supplement policy or certificate in force in the District shall contain benefits which duplicate benefits provided by Medicare.

2205.4

Subject to subsections 2206.7, 2206.8, 2206.13, 2207.7, and 2207.8, a Medicare supplement insurance policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006, shall be renewed for current policyholders who do not enroll in Part D at the option of the policyholder.

2205.5

A Medicare supplement policy with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.

2205.6

After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:

(a) The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Part D plan; and

(b) Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.

D.C. Mun. Regs. tit. 26, r. 26-A2205

Final Rulemaking published at 46 DCR 10175 (December 17, 1999); as amended by Final Rulemaking published at 50 DCR 4166 (May 30, 2003); as amended by Final Rulemaking published at 50 DCR 5882 (July 25, 2003); as amended by Final Rulemaking published at 53 DCR 2955(April 14, 2006); as amended by Final Rulemaking published at 56 DCR 8840 (November 13, 2009), incorporating text of Proposed Rulemaking published at 56 DCR 7661 (September 25, 2009)

Authority: Sections 4, 5, 6, 9, and 11 of the Medicare Supplement Insurance Minimum Standards Act of 1992, effective July 22, 1992 (D.C. Law 9-170; D.C. Official Code §§ 31-3703, 31-3704, 31-3705, 31-3708 and 31-3710 (2001)), and section 4 of Department of Insurance and Securities Regulation Establishment Act of 1996, effective May 21 , 1997 (D.C. Law 11-268; D.C. Official Code § 31-103 (2009 Supp.))