6.6.506    PROHIBITED POLICY PROVISIONS

(1) Except for permitted preexisting condition clauses as described in ARM 6.6.507(1)(a)(i) and 6.6.507D(1)(a)(i), no policy or certificate may be advertised, solicited, or issued for delivery in this state as a Medicare supplement policy if such 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 contract or certificate in force in the state of Montana shall contain benefits which duplicate benefits provided by Medicare.

(4) Subject to ARM 6.6.507(1)(a)(iv) and (v):

(a) a Medicare supplement policy or certificate with benefits for outpatient prescription drugs in existence prior to January 1, 2006, must be renewed for current policyholders or certificateholders who do not enroll in Part D at the option of the policyholder or certificateholder;

(b) a Medicare supplement policy or certificate with benefits for outpatient prescription drugs may not be issued after December 31, 2005; and

(c) after December 31, 2005, a Medicare supplement policy or certificate with benefits for outpatient prescription drugs may not be renewed after the policyholder or certificateholder enrolls in Medicare Part D unless:

(i) the policy or certificate is modified to eliminate outpatient drugs incurred after the effective date of the individual's coverage under a Part D plan; and

(ii) 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.

 

History: 33-1-313, 33-22-904, 33-22-905, MCA; IMP, 33-15-303, 33-22-902, 33-22-904, 33-22-905, MCA; NEW, 1981 MAR p. 1474, Eff. 2/1/82; AMD, 1990 MAR p. 1688, Eff. 9/1/90; AMD, 1993 MAR p. 1487, Eff. 7/16/93; AMD, 2004 MAR p. 313, Eff. 2/13/04; AMD, 2005 MAR p. 1672, Eff. 9/9/05; AMD, 2009 MAR p. 1107, Eff. 7/17/09; AMD, 2018 MAR p. 572, Eff. 3/17/18.