California Health and Safety Code ARTICLE 3.5 - Additional Requirements for Medicare Supplement Contracts

• Section 1358.1.
  Every health care service plan that offers any contract that primarily or solely supplements Medicare or that is advertised or represented as a supplement to...
• Section 1358.2.
  The purpose of this article is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement contracts, to...
• Section 1358.3.
  (a)  Except as otherwise provided in this section or in Sections 1358.7, 1358.12, 1358.13, 1358.16, and 1358.21, this article shall apply to all group and...
• Section 1358.4.
  The following definitions apply for the purposes of this article:(a) “Applicant” means:(1) An individual enrollee who seeks to contract for health coverage, in the case of an...
• Section 1358.5.
  (a) A contract shall not be advertised, solicited, or issued for delivery as a Medicare supplement contract unless the contract contains definitions or terms that conform...
• Section 1358.6.
  (a) (1) Except for permitted preexisting condition clauses as described in Sections 1358.7, 1358.8, and 1358.81, a contract shall not be advertised, solicited, or issued for delivery...
• Section 1358.7.
  A contract shall not be advertised, solicited, or issued for delivery as a Medicare supplement contract prior to January 1, 2001, unless it meets or...
• Section 1358.8.
  The following standards are applicable to all Medicare supplement contracts advertised, solicited, or issued for delivery on or after January 1, 2001, and with an...
• Section 1358.81.
  The following standards are applicable to all Medicare supplement contracts delivered or issued for delivery in this state with an effective date on or after...
• Section 1358.9.
  The following standards are applicable to all Medicare supplement contracts delivered or issued for delivery in this state on or after July 21, 1992, and...
• Section 1358.91.
  The following standards are applicable to all Medicare supplement contracts delivered or issued for delivery in this state with an effective date on or after...
• Section 1358.10.a.
  (a) (1) This section shall apply to Medicare Select contracts, as defined in this section.(2) A contract shall not be advertised as a Medicare Select contract unless it...
• Section 1358.11.
  (a) (1) An issuer shall not deny or condition the offering or effectiveness of any Medicare supplement contract available for sale in this state, nor discriminate in...
• Section 1358.12.
  (a) (1) With respect to the guaranteed issue of a Medicare supplement contract, eligible persons are those individuals described in subdivision (b) who seek to enroll under...
• Section 1358.13.
   (a) An issuer shall comply with Section 1882(c)(3) of the federal Social Security Act (as enacted by Section 4081(b)(2)(C) of the federal Omnibus Budget Reconciliation Act...
• Section 1358.14.
  (a)  (1)  (A)  With respect to loss ratio standards, a Medicare supplement contract shall not be advertised, solicited, or issued for delivery unless the contract...
• Section 1358.145.
  (a)  The calculation of actual or expected loss ratios shall be pursuant to the formula in subdivision (a) of Section 1358.14, and pursuant to definitions,...
• Section 1358.146.
  The following format shall be used for reporting loss ratio experience:MEDICARE SUPPLEMENT HEALTH CARE SERVICE PLAN CONTRACT EXPERIENCE EXHIBITFor the year ended December 31, 20__....
• Section 1358.15.
  (a) An issuer shall not advertise, solicit, or issue for delivery a Medicare supplement contract to a resident of this state unless the contract has been...
• Section 1358.16.
  (a)  An issuer or other entity may provide a commission or other compensation to a solicitor or other representative for the sale of a Medicare...
• Section 1358.17.
  (a) (1) Medicare supplement contracts shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent with subdivision (a) of Section...
• Section 1358.18.
  In the interest of full and fair disclosure, and to ensure the availability of necessary consumer information to potential subscribers or enrollees not possessing a...
• Section 1358.19.
  An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio, or television medium to...
• Section 1358.20.a.
  (a) An issuer, directly or through solicitors or other representatives, shall do each of the following:(1) Establish marketing procedures to ensure that any comparison of Medicare supplement...
• Section 1358.21.
  (a)  In recommending the purchase or replacement of any Medicare supplement coverage, an issuer or its representative shall make reasonable efforts to determine the appropriateness...
• Section 1358.22.
  (a) On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the...
• Section 1358.225.
  (a)  Every issuer shall, by June 30 of each year, file with the director a list of its Medicare supplement contracts offered or issued or...
• Section 1358.23.
  (a)  If a Medicare supplement contract replaces another Medicare supplement policy or certificate, or contract, the replacing issuer shall waive any time periods applicable to...
• Section 1358.24.
  This section applies to all contracts that become effective on or after May 21, 2009.(a) In addition to the requirements set forth under Sections 1365.5 and...

Last modified: October 22, 2018