Md. Code Regs. 31.10.06.06

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.10.06.06 - Open Enrollment

A. Period of Open Enrollment.

(1) An issuer may 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 the policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant when:

(a) An application for the policy or certificate is submitted during the 6-month period beginning with the first day of the first month in which an individual is both 65 years old or older and is enrolled for benefits under Medicare Part B; or

(b) An application for the policy or certificate is submitted on or up to 30 days after the birthday of an individual enrolled in a Medicare supplement policy or certificate.

(2) Each Medicare supplement policy and certificate currently available from an issuer shall be made available to all applicants who qualify under §A(1)(a) of this regulation without regard to age.

(3) Subject to Regulation .31A of this chapter, an insurer shall make available to applicants who qualify under §A(1)(b) of this regulation Medicare supplement policies or certificates with benefits that are equal to or less than the benefits of the applicant's existing Medicare supplement policy or certificate. For the purpose of this regulation, "benefits that are equal to or less than the benefits of the applicant's existing Medicare supplement policy or certificate" means a policy or certificate of the same or lower benefit level as indicated in the below chart:

Existing Plan	Lesser or Equal Plan
Plan A	Plan A
Plan B	Plan A or B
Plan C	Plan A, B, C, D, K, L, M, or N
Plan D	Plan A, B, D, K, L, M, or N
Plan E	Plan A, B, D, K, L, M, or N
Plan F	Plan A, B, C, D, F, F with a high deductible, G, G with a high deductible, K, L, M, or N
Plan F with a high deductible	Plan F with a high deductible or G with a high deductible
Plan G	Plan A, B, D, G, K, L, M, N, F with a high deductible, or G with a high deductible
Plan G with a high deductible	Plan G with a high deductible
Plan H	Plan A, B, D, K, L, M, or N
Plan I	Plan A, B, D, G, K, L, M, or N
Plan J	Plan A, B, C, D, F, F with a high deductible, G, G with a high deductible, K, L, M, or N
Plan J with a high deductible	Plan F with a high deductible or G with a high deductible
Plan K	Plan K
Plan L	Plan K or L
Plan M	Plan M or N
Plan N	Plan N

B. Application of Creditable Coverage.

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

(2) If the applicant qualifies under §A of this regulation and submits an application during the time period referenced in §A of this regulation and, as of the date of application, has had a continuous period of creditable coverage that is less than 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.

(3) The Secretary shall specify the manner of the reduction under §B(2) of this regulation.

C. Except as provided in §B of this regulation and in Regulations .09-1 and .18 of this chapter, §A of this regulation is not to be construed as preventing the exclusion of benefits under a policy during the first 6 months based on a preexisting condition for which the policyholder or certificate holder received treatment or was otherwise diagnosed during the 6 months before the policy became effective.

D. Individuals Younger than 65 Years Old and Enrolled in Medicare Part B. An issuer shall comply with the open enrollment requirements that are described in Insurance Article, § 15-909, Annotated Code of Maryland, as applying to individuals who are both younger than 65 years old and enrolled in Part B of Medicare.

Md. Code Regs. 31.10.06.06

Regulations .06 adopted as an emergency provision effective July 14, 1992 (19:16 Md. R. 1466); adopted permanently effective August 3, 1992 (19:15 Md. R. 1389)
Regulation .06 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489); amended effective 50:16 Md. R. 729, eff. 8/21/2023