02-031 C.M.R. ch. 275, § 11 - Open Enrollment

A. Each Medicare beneficiary shall be entitled to a 6-month open enrollment period beginning on the date he or she first enrolls for benefits under Medicare Part B, and each individual enrolled for benefits under Medicare Part B before turning 65 shall be entitled to an additional 6-month open enrollment period beginning on his or her 65th birthday. An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of such a policy or certificate because of the applicant's health status, claims experience, receipt of health care, or medical condition, if the application date falls during the applicant's open enrollment period or during the preceding 60 days. In the case of an application preceding the open enrollment period, the issuer may defer the effective date of the Medicare supplement policy until the first day of the open enrollment period. Each Medicare supplement policy and certificate currently available from an issuer shall be made available to all applicants who qualify under this subsection without regard to age.

B.

(1) If an applicant qualifies under Subsection A and submits an application during the time period referenced in Subsection A and, as of the date of application, has had a continuous period of creditable coverage of at least six (6) months, the issuer shall not exclude benefits based on a preexisting condition.

(2) If the applicant qualifies under Subsection A and submits an application during the time period referenced in Subsection A and, as of the date of application, has had a continuous period of creditable coverage that is less than six (6) months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. For example, if a beneficiary did not have creditable coverage prior to enrolling in Medicare Part A and Part B at age 65 and then purchases a Medicare supplement policy with a six-month preexisting condition exclusion at month 5 of the open enrollment period, the preexisting condition exclusion period must be reduced to one month because Medicare is creditable coverage. This example pertains only to Subsections A and B and does not preclude the insurer from underwriting or refusing to issue a policy if the insured does not elect a Medicare supplement policy during the 6-month period described in Subsection A or is otherwise provided for in Subsection B and Sections 12 and 23.

C. Except as provided in Subsection B and Sections 12 and 23, Subsection A shall not be construed as preventing the exclusion of benefits under a policy, during the first six (6) months, based on a preexisting condition for which the policyholder or certificate holder received treatment or was otherwise diagnosed during the six (6) months before the coverage became effective.

Notes

02-031 C.M.R. ch. 275, § 11