Sec. 38a-495c. Medicare supplement premium rates charged on a community rate basis. Age, gender, previous claim or medical history rating prohibited. Exceptions. Preexisting conditions. Exceptions. Co
Sec. 38a-495c. Medicare supplement premium rates charged on a community
rate basis. Age, gender, previous claim or medical history rating prohibited. Exceptions. Preexisting conditions. Exceptions. Coverage for the disabled. Regulations.
(a) Each insurance company, fraternal benefit society, hospital service corporation, medical service corporation, health care center or other entity in this state, on or after January
1, 1994, which delivers, issues for delivery, continues or renews any Medicare supplement insurance policies or certificates shall base the premium rates charged on a community rate. Such rate shall not be based on age, gender, previous claims history or the
medical condition of the person covered by such policy or certificate. Except as provided
in subsection (c) of this section, coverage shall not be denied on the basis of age, gender,
previous claim history or the medical condition of the person covered by such policy
or certificate, except for plans "H" to "J", inclusive, as provided in section 38a-495b.
In plans "H" to "J", inclusive, previous claims history and the medical condition of the
applicant may be used in determinations to grant coverage under Medicare supplement
policies and certificates issued prior to January 1, 2006.
(b) Nothing in this section shall prohibit an insurance company, fraternal benefit
society, hospital service corporation, medical service corporation, health care center or
other entity in this state issuing Medicare supplement insurance policies or certificates
from using its usual and customary underwriting procedures, provided no such company,
society, corporation, center or other entity shall issue a Medicare supplement policy or
certificate based on the age, gender, previous claims history or the medical condition
of the applicant, except that the previous claims history and the medical condition of the
applicant may be used in determinations to grant coverage under Medicare supplement
policies and certificates issued prior to January 1, 2006, for plans "H" to "J", inclusive.
(c) Nothing in this section shall prohibit an insurance company, fraternal benefit
society, hospital service corporation, medical service corporation, health care center or
other entity in this state when granting coverage under a Medicare supplement policy
or certificate from excluding benefits for losses incurred within six months from the
effective date of coverage based on a preexisting condition, in accordance with section
38a-495a and the regulations adopted pursuant to section 38a-495a.
(d) Each insurance company, fraternal benefit society, hospital service corporation,
medical service corporation, health care center or other entity in the state issuing Medicare supplement policies or certificates for plan "A", "B" or "C", or any combination
thereof, to persons eligible for Medicare by reason of age, shall offer for sale the same
such policies or certificates to persons eligible for Medicare by reason of disability.
(e) Each insurance company, fraternal benefit society, hospital service corporation,
medical service corporation, health care center or other entity in the state issuing Medicare supplement policies or certificates shall make all necessary arrangements with the
Medicare Part B carrier and all Medicare Part A intermediaries to allow for the forwarding, to the issuing entity, of all Medicare claims containing the name of the entity issuing
a Medicare supplement policy or certificate and the identification number of an insured.
The entity issuing the Medicare supplement policy or certificate shall process all benefits
available to an insured from a Medicare claim so forwarded, without requiring any
additional action on the part of the insured.
(f) The provisions of this section shall apply to all Medicare supplement policies
or certificates issued on and after January 1, 1994. For Medicare supplement policies
or certificates issued prior to January 1, 1994, the provisions of this section shall apply
as of the first rating period commencing on or after January 1, 1994, but no later than
January 1, 1995.
(g) The Insurance Commissioner may adopt regulations, in accordance with chapter
54, to implement this section.
(P.A. 93-390, S. 2, 8; Oct. Sp. Sess. P.A. 93-1, S. 1, 2; P.A. 98-32; P.A. 05-20, S. 5.)
History: P.A. 93-390 effective January 1, 1994; Oct. Sp. Sess. P.A. 93-1 inserted new Subsec. (c) re exclusion of benefits
for losses incurred within six months from the effective date of coverage based on a preexisting condition and relettered
the remaining Subsecs. accordingly, effective January 1, 1994 (Revisor's note: In Subsecs. (d) and (e) the references to
"other entities in the state" were changed editorially by the Revisors to "other entity in the state" for consistency with the
language in Subsecs. (a), (b) and (c)); P.A. 98-32 amended Subsec. (d) to require those who issue Medicare supplements
for plans "A", "B" or "C", or any combination thereof, on the basis of age to offer the same policy to persons eligible for
Medicare by reason of disability, and deleted requirement that companies which issue Medicare supplements on basis of
age must offer at least one such policy on basis of disability; P.A. 05-20 made technical changes throughout, amended
Subsecs. (a) and (b) to reference "determinations to grant coverage" and plans "H" to "J", inclusive, "issued prior to January
1, 2006," re use of claims history and medical condition, and amended Subsec. (g) re regulations, effective July 1, 2005.