Michigan Compiled Laws 218-1956-38 Chapter 38 Medicare Supplement Policies And Certificates (500.3801...500.3861)

• Section 500.3801 Chapter; Definitions.
  As used in this chapter: (a) "Applicant" means: (i) For an individual medicare supplement policy, the person who seeks to contract for benefits. (ii)...
• Section 500.3803 Applicability Of Chapter.
  (1) Except as provided in subsections (2) and (3), this chapter applies to a medicare supplement policy delivered, issued for delivery, or renewed in...
• Section 500.3804 Applicability Of Chapter.
  This chapter applies to a medicare supplement policy delivered, issued for delivery, or renewed by a health care corporation operating pursuant to the nonprofit...
• Section 500.3805 Medicare Supplement Policy; Definitions.
  As used in a medicare supplement policy: (a) The definition of "accident", "accidental injury", or "accidental means" shall not include words that establish an...
• Section 500.3807 Basic Core Package Of Benefits; Standards For Plans K And L; Applicability Of Section.
  (1) Every insurer issuing a medicare supplement insurance policy in this state shall make available a medicare supplement insurance policy that includes a basic...
• Section 500.3807a Medicare Supplement Policies Or Certificates With Effective Date For Coverage On Or After June 1, 2010; Basic Core Package Of Benefits.
  (1) This section applies to all medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or...
• Section 500.3808 Medicare Supplement Insurance Policy; Availability Of Benefits In Mcl 500.3811(5)(c) Or 500.3811a(6)(c).
  Every insurer issuing a medicare supplement insurance policy in this state shall make available a medicare supplement insurance policy that includes the benefits provided...
• Section 500.3809 Additional Benefits; Reimbursement For Preventive Screening Tests And Services; Definitions; Applicability Of Section.
  (1) In addition to the basic core package of benefits required under section 3807, the following benefits may be included in a medicare supplement...
• Section 500.3809a Medicare Supplement Policies Or Certificates With Effective Date For Coverage On Or After June 1, 2010; Additional Benefits.
  (1) This section applies to all medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or...
• Section 500.3811 Basic Core Benefits; Availability; Sale Of Certain Benefits Prohibited; Designations, Structure, Language, And Format; Other Designations; Requirements; Applicability Of Section.
  (1) An insurer shall make available to each prospective medicare supplement policyholder and certificate holder a policy form or certificate form containing only the...
• Section 500.3811a Medicare Supplement Policies Or Certificates With Effective Date For Coverage On Or After June 1, 2010; Basic Core Benefits; Availability; Sale Of Certain Benefits Prohibited; Structure, Language, Designation, And Format; Other Designations; Requirements.
  (1) This section applies to all medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or...
• Section 500.3813 Disability Coverage; Medicare Supplement Buyer's Guide; Applicability Of Section.
  An insurer that issues a policy that provides disability coverage to a person eligible for medicare by reason of age shall provide the prospective...
• Section 500.3815 Outline Of Coverage; Acknowledgment Of Receipt; Compliance With Notice Requirements; Substitute; Language, Format, And Required Items.
  (1) An insurer that offers a medicare supplement policy shall provide to the applicant at the time of application an outline of coverage and,...
• Section 500.3817 Medicare Select Policies And Certificates; Definitions; Requirements For Issuance; Plan Of Operation; Filing, Format, And Contents; Proposed Changes; Updated List Of Network Providers; Payment For Covered Services Not Available Through Network Providers; Disclosure; Receipt Of Information; Grievance Procedure; Report; Availability Of Comparable Or Lesser Benefits; Continuation Of Coverage; Requests For Data By State Or Federal Agencies.
  (1) This section applies to medicare select policies and certificates. (2) As used in this section: (a) "Complaint" means any dissatisfaction expressed by an...
• Section 500.3819 Minimum Standards; Suspension Of Benefits And Premiums; Notice; Reinstitution; Offer To Exchange 1990 Standardized Plan To 2010 Plan.
  (1) An insurance policy shall not be titled, advertised, solicited, or issued for delivery in this state as a medicare supplement policy if the...
• Section 500.3819a Medicare Supplement Policies Or Certificates With Effective Date For Coverage On Or After June 1, 2010; Minimum Standards.
  (1) This section applies to all medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or...
• Section 500.3821 Issuance Of Policy To Person Not Enrolled In Medicare Parts A And B Prohibited; Refund; Interest.
  (1) An insurer shall not issue an individual medicare supplement policy to a person who has not applied for or enrolled in medicare, parts...
• Section 500.3823 Covered Benefits More Restrictive Than Benefits Under Medicare And Required Under State Law Prohibited; Benefits For Outpatient Prescription Drugs.
  (1) An insurance policy shall not be titled, advertised, solicited, or issued for delivery in this state as a medicare supplement policy unless the...
• Section 500.3825 Preexisting Diseases Or Conditions; Waiver Prohibited.
  A medicare supplement policy shall not use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or...
• Section 500.3827 Duplicate Benefits Prohibited; Application; Statements And Questions Whether Another Policy In Force; List Of Policies Sold To Applicant; Notice Regarding Replacement Coverage.
  (1) A medicare supplement insurance policy or certificate shall not be delivered or issued for delivery in this state if the policy or certificate...
• Section 500.3829 Denying Or Conditioning Issuance Based On Health Status, Claims Experience, Receipt Of Health Care, Or Medical Condition Of Applicant Prohibited; Condition; Exclusion Of Benefits Based On Preexisting Conditions; Reduction; Creditable Coverage.
  (1) An insurer shall not deny or condition the issuance or effectiveness of a medicare supplement policy available for sale in this state, or...
• Section 500.3829a Medicare Supplement Policies Or Certificates Delivered, Issued For Delivery, Or Renewed On Or After May 21, 2009; Genetic Test; Definitions.
  (1) This section applies to all medicare supplement policies or certificates delivered, issued for delivery, or renewed on or after May 21, 2009. (2)...
• Section 500.3830 Eligible Person; Requirements.
  (1) An eligible person is an individual described in subsection (2) who applies to enroll under a medicare supplement policy during the period described...
• Section 500.3830a Termination Of Contract Or Agreement; Notice To Individual.
  (1) At the time of an event described in section 3830(2) because of which an individual loses coverage or benefits due to the termination...
• Section 500.3831 Individual Or Group Expense Incurred Hospital, Medical, Or Surgical Policies; Right Of Continuation, Conversion, Or Type C Medicare Supplemental Package; Request For Coverage; Exclusion From Preexisting Conditions; Notice Of Availability Of Coverage; Utilization Of Another Insurer To Write Coverage.
  (1) Each insurer offering individual or group expense incurred hospital, medical, or surgical policies or certificates in this state shall provide without restriction, to...
• Section 500.3833 Replacement Policy; Waiver Of Certain Time Periods.
  If a medicare supplement policy or certificate replaces another medicare supplement policy, certificate, or contract, the replacing insurer shall waive any time periods applicable...
• Section 500.3835 Marketing Procedures; Determining Appropriateness Of Recommended Purchase Or Replacement; More Than 1 Policy Prohibited; Individual Enrolled In Medicare Advantage; “notice To Buyer” Displayed.
  (1) Each insurer marketing medicare supplement insurance coverage in this state directly or through its agents shall do all of the following: (a) Establish...
• Section 500.3837 Repealed. 2002, Act 304, Imd. Eff. May 10, 2002.
  Compiler's Notes: The repealed section pertained to report to commissioner.Popular Name: Act 218
• Section 500.3839 Renewal Or Continuation Provision; Effect Of Termination Or Replacement; Elimination Of Outpatient Prescription Drug Benefit.
  (1) Each medicare supplement policy shall include a renewal or continuation provision. The provision shall be appropriately captioned, shall appear on the first page...
• Section 500.3841 Riders Or Endorsements; Signed Acceptance Or Agreement; Additional Premium; Use Of Certain Standards, Terms, And Words; Filing Of Changes In Medicare Benefits; Elimination Of Duplicate Benefits; Notice Of Modifications; Notice Requirements Of Medicare Prescription Drug, Improvement, And Modernization Act Of 2003.
  (1) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured, exercises a specifically reserved right...
• Section 500.3843 Disability Insurance; Notice; Contents; Applicability Of Subsection (1).
  (1) Any policy or certificate of disability insurance issued for delivery in this state to persons eligible for medicare by reason of age shall...
• Section 500.3847 Advertising; Filing Copy With Commissioner.
  Each insurer providing medicare supplement insurance coverage in this state shall file with the commissioner for review a copy of any written, radio, or...
• Section 500.3849 Filing And Approval Requirements; Deletion Of Outpatient Prescription Drug Benefits; Issuance Of Policy; Use And Change In Premium Rates; Additional Forms; Availability; Conditions And Effect Of Discontinuance; Combining Forms For Purposes Of Refund Or Credit Calculation; Compliance With Federal Law; “type” Defined.
  (1) An insurer shall not deliver or issue for delivery a medicare supplement policy to a resident of this state unless the policy form...
• Section 500.3851 Aggregate Benefits; Rates, Rating Schedules, And Rate Revisions.
  (1) A medicare supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form or certificate form...
• Section 500.3852 Benchmark Ratio.
  An insurer shall file by May 31 of each year a reporting form for the calculation of benchmark ratio since inception in a format...
• Section 500.3853 Refund Or Credit Calculation; Form; Interest; Due Date.
  If on the basis of the experience as reported by an insurer under section 3852 the benchmark ratio since inception (ratio 1) exceeds the...
• Section 500.3855 Annual Filing Of Rates, Rating Schedule, And Supporting Documentation; Premium Adjustments; Public Hearing For Rate Increase; Failure To Make Premium Adjustments.
  (1) Each insurer that issues medicare supplement policies for delivery in this state shall file annually with the commissioner, on a form and in...
• Section 500.3857 Duties Of Insurer; Certification Of Compliance With Subsection (1)(a).
  (1) An insurer shall do all of the following: (a) Accept a notice from a medicare carrier on dually assigned claims submitted by participating...
• Section 500.3859 Prohibited Conduct; Violation As Misdemeanor; Penalty.
  (1) A person shall not knowingly sell a health insurance policy or certificate to an individual entitled to benefits under part A or enrolled...
• Section 500.3861 Probable Cause Of Violation; Notice Of Hearing; Opportunity To Confer And Discuss; Hearing; Applicability Of Mcl 500.2038 To 500.2040; Violation; Penalty.
  (1) If the commissioner has probable cause to believe that an insurer or agent has violated or is violating this chapter and that a...

Last modified: October 10, 2016