Article 6. Medicare Supplement Policies - California Insurance Code Section 10192.15
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California Laws > Insurance Code > Article 6. Medicare Supplement Policies - California Insurance Code Section 10192.15
10192.15. (a) An issuer shall not advertise, solicit, or issue for
delivery a policy or certificate to a resident of this state unless
the policy form or certificate form has been filed with and approved
by the commissioner in accordance with filing requirements and
procedures prescribed by the commissioner. Master policies issued
outside California shall be filed for informational purposes along
with the certificates. Until January 1, 2001, or 90 days after
approval of Medicare supplement policies or certificates submitted
for approval pursuant to this section, whichever is later, issuers
may continue to offer and market previously approved Medicare
supplement policies or certificates.
(b) An issuer shall file any riders or amendments to policy or
certificate forms to delete outpatient prescription drug benefits, as
required by the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (P.L. 108-173), only with the commissioner
in the state where the policy or certificate was issued.
(c) (1) An issuer shall not use or change premium rates for a
Medicare supplement policy or certificate unless the rates, rating
schedule, and supporting documentation have been filed with and
approved by the commissioner in accordance with the filing
requirements and procedures prescribed by the commissioner.
(2) Paragraph (1) of subdivision (b) of Section 10290 shall not
apply to Medicare supplement insurance forms or rates. However, the
commissioner may authorize in writing, for good cause only, the
limited use of a form or rates after that form or the rates have been
filed with the commissioner for 60 days and have not otherwise been
(d) (1) Except as provided in paragraph (2), an issuer shall not
file for approval more than one form of a policy or certificate of
each type for each standard Medicare supplement benefit plan.
(2) An issuer may offer, with the approval of the commissioner, up
to four additional policy forms or certificate forms of the same
type for the same standard Medicare supplement benefit plan, one for
each of the following cases:
(A) The inclusion of new or innovative benefits.
(B) The addition of either direct response or agent marketing
(C) The addition of either guaranteed issue or underwritten
(D) The offering of coverage to individuals eligible for Medicare
by reason of disability.
(3) For the purposes of this section, a "type" means an individual
policy, a group policy, an individual Medicare Select policy, or a
group Medicare Select policy.
(e) (1) Except as provided in subdivision (a), an issuer shall
continue to make available for purchase any policy form or
certificate form issued after January 1, 2001, that has been approved
by the commissioner. A policy form or certificate form shall not be
considered to be available for purchase unless the issuer has
actively offered it for sale in the previous 12 months.
(A) An issuer may discontinue the availability of a policy form or
certificate form if the issuer provides to the commissioner in
writing its decision at least 60 days prior to discontinuing the
availability of the form of the policy or certificate. After receipt
of the notice by the commissioner, the issuer shall no longer offer
for sale the policy form or certificate form in this state.
(B) An issuer that discontinues the availability of a policy form
or certificate form pursuant to subparagraph (A) shall not file for
approval a new policy form or certificate form of the same type for
the same standard Medicare supplement benefit plan as the
discontinued form for a period of five years after the issuer
provides notice to the commissioner of the discontinuance. The period
of discontinuance may be reduced if the commissioner determines that
a shorter period is appropriate.
(2) The sale or other transfer of Medicare supplement business to
another issuer shall be considered a discontinuance for the purposes
of this subdivision.
(3) A change in the rating structure or methodology shall be
considered a discontinuance under paragraph (1) unless the issuer
complies with the following requirements:
(A) The issuer provides an actuarial memorandum, in a form and
manner prescribed by the commissioner, describing the manner in which
the revised rating methodology and resultant rates differ from the
existing rating methodology and existing rates. The commissioner may
approve the change if it is in the public interest.
(B) The issuer does not subsequently put into effect a change of
rates or rating factors that would cause the percentage differential
between the discontinued and subsequent rates as described in the
actuarial memorandum to change. The commissioner may approve a change
to the differential that is in the public interest. The commissioner
may approve a change to the differential if it is in the public
(f) (1) Except as provided in paragraph (2), the experience of all
policy forms or certificate forms of the same type in a standard
Medicare supplement benefit plan shall be combined for purposes of
the refund or credit calculation prescribed in Section 10192.14.
(2) Forms assumed under an assumption reinsurance agreement shall
not be combined with the experience of other forms for purposes of
the refund or credit calculation.
Last modified: February 16, 2015