HOUSE OF REPRESENTATIVES |
H.B. NO. |
539 |
THIRTY-SECOND LEGISLATURE, 2023 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
Relating to Medicare Supplement Insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
The purpose of this Act is to require issuers of medigap insurance in the State to accept an individual's application for coverage or an enrollee's application to switch to another eligible plan at any time throughout the year, and prohibit issuers from denying the applicant a medigap policy or certificate or make any premium rate distinctions because of health status, claims experience, medical condition, or whether the applicant is receiving health care services.
SECTION 2. Section 431:10A-304, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-304 Standards for policy provisions. (a) No medicare supplement policy or certificate in force in the State shall contain benefits that duplicate benefits provided by medicare.
(b) The commissioner shall adopt reasonable rules to establish specific standards for the provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this State, including the provisions of part I of this article. No requirement of this chapter relating to minimum required policy benefits, other than the minimum standards contained in this part, shall apply to medicare supplement policies and certificates. The standards may cover, but shall not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions, and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definition of terms.
(c) The commissioner may adopt reasonable rules that specify prohibited policy provisions not otherwise specifically authorized by law, which, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under any medicare supplement policy or certificate.
(d) A medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months after the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than 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 coverage.
(e) No issuer of medicare supplement insurance policies or certificates in the State shall deny or condition the issuance or effectiveness of any medicare supplement policy or certificate available for sale in the State, nor discriminate in the pricing of the policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant. Applicants shall be accepted at all times throughout the year for any medicare supplement insurance benefit plan available from an issuer. The requirements of this subsection shall be applicable to applicants enrolled for benefits under medicare part B, whether by reason of age or by reason of disability."
SECTION 3. The insurance commissioner shall amend or adopt rules consistent with the requirements of this Act.
SECTION 4. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.
SECTION 5. New statutory material is underscored.
SECTION 6. This Act shall take effect upon its approval.
INTRODUCED BY: |
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Report Title:
Medicare Supplement Insurance; Medigap Insurance; Guaranteed-Issue Open Enrollment Period; Insurance Commissioner; Rules
Description:
Requires issuers of Medigap insurance in the State to accept an eligible individual's application for coverage at any time throughout the year and prohibits issuers from denying the applicant a Medigap policy or certificate or make any premium rate distinctions because of health status. Requires the Insurance Commissioner to amend or adopt rules accordingly.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.