To update Chapter 69O-156 to allow for a revision of prior products and new product generation by adopting revisions to the NAIC Model Regulation.

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NOS.:RULE TITLES:

69O-156.003Definitions

69O-156.0075Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010.

PURPOSE AND EFFECT: To update Chapter 69O-156, F.A.C. to allow for a revision of prior products and new product generation by adopting revisions to the NAIC Model Regulation.

SUMMARY: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015, and prohibits the sale of Medigap policies that cover Part B deductibles to “newly eligible” Medicare beneficiaries. On August 29, 2016, the National Association of Insurance Commissioners (NAIC) adopted revisions to the NAIC Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act (NAIC Model Regulation) to comply with MACRA. 69O-156.003 and 69O-156.0075 are amended to comply with amendments to the NAIC Model Regulation by NAIC.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Agency personnel familiar with the subject matter of the rule amendment have performed an economic analysis of the rule amendment that shows that the rule amendment is unlikely to have an adverse impact on the State economy in excess of the criteria established in Section 120.541(2)(a), Florida Statutes.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 624.308(1), 627.6274(2), 627.6741(5) FS.

LAW IMPLEMENTED: 624.307(1), 627.410, 627.674, 627.6741 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Michael Lawrence, Jr., Assistant General Counsel, Office of Insurance Regulation, [e-mail], [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69O-156.003 Definitions.

For purposes of this rule:

(1) through (13) No change.

(14) “Newly Eligible Medicare Beneficiary” means anyone who attains age 65 on or after January 1, 2020, or who first becomes eligible for Medicare benefits due to age, disability, or end-stage renal disease on or after January 1, 2020.

(15)(14) “Policy” as used herein is as defined in Section 627.672, F.S.

(16)(15) “Policy Form” means the form on which the policy is delivered or issued for delivery by the issuer.

(17)(16) “Pre-existing condition” shall not be defined to limit or preclude liability under a policy for a period longer than six (6) months because of a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of the coverage.

(18)(17) “Pre-Standardized Medicare supplement benefit plan,” “Pre-Standardized benefit plan” or “Pre-Standardized plan” means a group or individual policy of Medicare supplement insurance issued prior to January 1, 1992.

(19)(18) “1990 Standardized Medicare supplement benefit plan,” “1990 Standardized benefit plan” or “1990 plan” means a group or individual policy of Medicare supplement insurance issued on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010.

(20)(19) “2010 Standardized Medicare supplement benefit plan,” “2010 Standardized benefit plan” or “2010 plan” means a group or individual policy of Medicare supplement insurance with an effective date for coverage on or after June 1, 2010.

(21) “2020 Standardized Medicare supplement benefit plan,” “2020 Standardized benefit plan” or “2020 plan” means an individual policy of Medicare supplement insurance issued to individuals newly eligible for Medicare and with an effective date for coverage on or after January 1, 2020, except for individuals eligible for Medicare prior to January 1, 2020, that are eligible for Medicare supplement benefit Plans C, F, and High Deductible F.

(22)(20) “Replacement” is any transaction wherein new Medicare supplement insurance is to be purchased and it is known to the agent, broker or insurer at the time of application that, as a part of the transaction, existing accident and health insurance has been or is to be lapsed or the benefits thereof substantially reduced.

(23)(21) “Secretary” means the Secretary of the United States Department of Health and Human Services.

Rulemaking Authority 624.308(1), 627.674(2), 627.6741(5) FS. Law Implemented 624.307(1), 627.674, 627.6741 FS. History–New 1-1-81, Formerly 4-51.03, Amended 11-7-88, 9-4-89, 12-9-90, Formerly 4-51.003, Amended 1-1-92, 7-14-96, 7-26-99, 3-4-01, Formerly 4-156.003, Amended 9-15-05, 1-4-10,  ____________.

 

69O-156.0075 Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or After June 1, 2010

The following standards are applicable to all 2010 Standardized Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. No issuer may offer any 1990 Standardized Medicare supplement benefit plan for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage prior to June 1, 2010, remain subject to the requirements of Rules 69O-156.006, 69O-156.007, and 69O-156.008, F.A.C.  

(1) No change.

(2) Standards for Basic (Core) Benefits Common to Medicare Supplement Insurance Benefit Plans A, B, C, D, F, F with High Deductible, G, M, and N. Every issuer of Medicare supplement insurance benefit plans shall make available a policy or certificate including only the following basic “core” package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in addition to the basic core package, but not in lieu of it.

(a) through (f) No change.

(g) Home Health Care (Parts A & B) Medicare Approved Services: Medically necessary skilled care services and medical supplies.

(3) No change.

Rulemaking Authority 624.308(1), 627.674(2)(a) FS. Law Implemented 624.307(1), 627.410, 627.674, 627.6741 FS. History–New 1-4-10, Amended ____________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Michael Lawrence, Jr., Assistant General Counsel, Office of Insurance Regulation, [e-mail], [phone].

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Financial Services Commission

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: July 25, 2019

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: April 10, 2019