Section 210-48-005 - Benefit conversion requirements005.01A Effective January 1, 1989, no Medicare supplement insurance policy, subscriber contract or certificate in force in this state shall contain benefits which duplicate benefits provided by Medicare. 005.01B General Requirements 005.01B(1) No later than thirty (30) days prior to the annual effective date of Medicare benefit changes mandated by the Medicare Catastrophic Coverage Act of 1988, every insurer, health care service plan, hospital and medical service association or health maintenance organization providing Medicare supplement insurance or benefits to a resident of this state shall notify its policyholders, subscribers and certificateholders of modifications it has made to Medicare supplement insurance policies or subscriber contracts. Such notice shall be in a format prescribed by the Director. 005.01B1(a) Such notice shall include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement insurance policy or subscriber contract. 005.01B1(b) The notice shall inform each covered person as to when any premium adjustment due to changes in Medicare benefits will be made. 005.01B1(c) The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and simple terms so as to facilitate comprehension. Such notice shall not contain or be accompanied by any solicitation.005.01B(2) No modifications to an existing Medicare supplement policy or subscriber contract shall be made at the time of or in connection with the notice requirements of this regulation except to the extent necessary to eliminate duplication of Medicare benefits and any modifications necessary under the policy or subscriber contract to provide indexed benefit adjustment. 005.01B(3) As soon as practicable, but no later than forty-five (45) days after the effective date of the Medicare benefit changes, every insurer, health care service plan, hospital and medical service association or health maintenance organization providing Medicare supplement insurance in this state shall file with the Department, in accordance with the applicable filing procedures of this state: 005.01B(3)(a) Appropriate premium adjustments necessary to produce loss ratios as originally anticipated for the applicable policies or subscriber contracts. Such supporting documents as necessary to justify the adjustment shall accompany the filing. 005.01B(3)(b) Any appropriate riders, endorsements or policy forms needed to accomplish the Medicare supplement insurance modifications necessary to eliminate benefit duplications with Medicare. Any such riders, endorsements or policy forms shall provide a clear description of the Medicare supplement benefits provided by the policy or subscriber contract.005.01B(4) Upon satisfying the filing and approval requirements of this state, every insurer, health care service plan, hospital and medical service association or health maintenance organization providing Medicare supplement insurance in this state shall provide each covered person with any rider, endorsement or policy form necessary to eliminate any benefit duplications under the policy or subscriber contract with benefits provided by Medicare.005.01B(5) No insurer, health care service plan, hospital and medical service association or health maintenance organization shall require any person covered under a Medicare supplement policy or subscriber contract which was in force prior to January 1, 1989 to purchase additional coverage under such policy or contract unless such additional coverage was provided for in the policy or contract. 005.01B(6) Every insurer, health care service plan, hospital and medical service association or health maintenance organization providing Medicare supplement insurance or benefits to a resident of this state shall make such premium adjustments as are necessary to produce an expected loss ratio under such policy or subscriber contract as will conform with minimum loss ratio standards for Medicare supplement policies and which is expected to result in a loss ratio at least as great as that originally anticipated by the insurer, health care service plan, hospital and medical service association or health maintenance organization for such Medicare supplement insurance policies or subscriber contracts. No premium adjustment which would modify the loss ratio experience under the policy, other than the adjustments described herein, should be made with respect to a policy at any time other than upon its renewal date. Premium adjustments shall be in the form of refunds or premium credits and shall be made no later than upon renewal if a credit is given, or within sixty (60) days of the renewal date if a refund is provided to the premium payer.210 Neb. Admin. Code, ch. 48, § 005