OAR 836-052-0129
Policy Provisions
(1)
Except for permitted preexisting condition clauses as described in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(2)(a), 836-052-0134 (Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 1, 1992)(2)(a) and 836-052-0132 (Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date of Coverage on or After June 1, 2010)(1)(a), no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.(2)
No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.(3)
No Medicare supplement policy or certificate in force in the state shall contain benefits that duplicate benefits provided by Medicare.(4)
Intentionally left blank —Ed.(a)
Subject to OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(2)(d) and (e), 836-052-0134 (Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 1, 1992)(2)(d), (e) and (g) and 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(1)(d) and (e), a Medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006 may be renewed for current policyholders who do not enroll in Part D at the option of the policyholder.(b)
A Medicare supplement policy with benefits for outpatient prescription drugs may not be issued after December 31, 2005.(c)
After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:(A)
The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual’s coverage under a Part D plan; and(B)
Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.
Source:
Rule 836-052-0129 — Policy Provisions, https://secure.sos.state.or.us/oard/view.action?ruleNumber=836-052-0129.