§ 27-8-13-9 — Medicare supplement policies; standards; preexisting medical conditions

Indiana § 27-8-13-9

• Jurisdiction: Indiana
• Title 27: INSURANCE
• Art. 8: LIFE, ACCIDENT, AND HEALTH
• Ch. 13: Medicare Supplement Insurance

Text

(a) A Medicare supplement policy, contract, or
certificate in force in Indiana may not contain benefits that duplicate
benefits provided by Medicare. However, a change in Medicare
coverage that becomes effective after a Medicare supplement policy,
contract, or certificate is in force in Indiana and that causes a
duplication of benefits does not void the policy, contract, or certificate.
(b) The commissioner shall adopt rules under IC 4-22-2 to establish
specific standards for policy provisions of Medicare supplement
policies and certificates. Such standards shall be in addition to and in
accordance with Indiana law. No requirement of IC 27 relating to
minimum required policy benefits other than the minimum standards
contained in this chapter apply to Medicare supplement policies and
certificates. The standards may cover, but are not 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) definitions of terms.
(c) The commissioner may adopt rules under IC 4-22-2 that specify
prohibited policy provisions not specifically authorized by statute that,
in the opinion of the commissioner, are unjust, unfair, or unfairly
discriminatory to a person insured or proposed to be insured under a
Medicare supplement policy or certificate.
(d) Notwithstanding any other law, a Medicare supplement policy
or certificate shall not exclude or limit benefits for a loss incurred more
than six (6) months after the effective date of the policy because the
loss involves 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 (6) months before the effective
date of coverage.
(e) After June 30, 2020, an issuer that makes a Medicare
supplement policy or certificate available to a person who is at least
sixty-five (65) years of age and eligible for Medicare benefits as
described in 42 U.S.C. 1395c(1) shall make at least one (1) Medicare
supplement policy or certificate that meets the requirements of section
9.5 of this chapter available to an individual who is eligible for and
enrolled in Medicare by reason of disability as described in 42 U.S.C.
426 and 42 U.S.C. 423. This subsection expires January 1, 2025.

Legislative History

As added by P.L.255-1989, SEC.6. Amended by P.L.126-1992, SEC.7; P.L.227-2019, SEC.2; P.L.28-2024, SEC.1.