Ga. Comp. R. & Regs. R. 120-2-8-.15 - Filing and Approval of Policies and Certificates and Premium Rates
(1) An issuer shall
not deliver 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.
(2) 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 only with the Commissioner in the state in which the
policy or certificate was issued.
(3) 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.
(4)
(a) Except as provided in Paragraph (b) of
this subsection, 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.
(b) An issuer may
offer, with the approval of the Commissioner, up to four (4) 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:
1. The inclusion of new or innovative
benefits;
2. The addition of either
direct response or agent marketing methods;
3. The addition of either guaranteed issue or
underwritten coverage;
4. The
offering of coverage to individuals eligible for Medicare by reason of
disability.
(c) 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.
(5)
(a) Except as provided in Paragraph (a)(1),
an issuer shall continue to make available for purchase any policy form or
certificate form issued after the effective date of this regulation 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 twelve (12) months.
1. 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 thirty (30) 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.
2. An issuer that discontinues the
availability of a policy form or certificate form pursuant to Subparagraph 1.
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 (5) 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.
(b) The sale or other transfer of
Medicare supplement business to another issuer shall be considered a
discontinuance for the purposes of this subsection.
(c) A change in the rating structure or
methodology shall be considered a discontinuance under Paragraph (a) unless the
issuer complies with the following requirements:
1. 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.
2. 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.
(6)
(a)
Except as provided in Paragraph (b), 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
120-2-8-.14.
(b) 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.
(7) An issuer shall not present for filing or
approval a rate structure for its Medicare supplement policies or certificates
issued after the effective date of the amendment of this regulation based upon
attained age rating as a structure or methodology.
Notes
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