N.J. Admin. Code § 11:4-23.5

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-23.5 - Policy provisions

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy if the policy or certificate contains limitations or exclusions that are more restrictive than those of Medicare, except with respect to preexisting condition limitations.

(b) No Medicare supplement policy or certificate shall provide benefits which duplicate benefits provided by Medicare.

(c) No Medicare supplement policy or certificate shall use waiver endorsements or riders to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

(d) Subject to N.J.A.C. 11:4-23.6(b)4 and 7, 23.6(c), 23.7(c) and 23.8(b), a Medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006 shall be renewed for current policyholders who do not enroll in Medicare Part D at the option of the policyholder.

(e) A Medicare supplement policy with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.

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

1. The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Part D plan; and

2. 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.

N.J. Admin. Code § 11:4-23.5

Amended by R.1991 d.345, effective 7/1/1991.
See: 23 New Jersey Register 1264(a), 23 New Jersey Register 2014(a).
Deleted "Medicare Supplement", "may", "such policy"; added "shall", "as a Medicare supplement policy", "it" in (a). Added "outside the United States" in (a)10.
Changed "Supplement" to "supplement" and "may" to "shall" in (b), (c) and (d); added "endorsements or riders" to (d).
Added (e).
Amended by R.1993 d.26, effective 1/4/1993.
See: 24 New Jersey Register 12(a), 25 New Jersey Register 141(a).
Rule amended to conform to Medicare standards.
Amended by R.1996 d.295, effective 7/1/1996.
See: 28 New Jersey Register 1647(a), 28 New Jersey Register 3462(a).
Amended by R.2005 d.291, effective 9/6/2005. See: 37 New Jersey Register 1428(a), 37 New Jersey Register 3376(a).
Added (d) through (f).