N.J. Admin. Code § 11:4-23.9

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:4-23.9 - Open enrollment

(a) Carriers shall not deny or condition the effectiveness or issuance, nor discriminate in the pricing, of Medicare supplement policies or certificates based on the health status, claims experience, receipt of health care by, or medical condition of an applicant if the application is submitted for Medicare supplement coverage prior to or during the six month period beginning with the first day of the first month in which the applicant is 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate shall be made available to all applicants who qualify under this section without regard to age.

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

(c) If the applicant qualifies under (a) above and submits an application during the time period referenced in (a) above and, as of the date of application, has had a continuous period of creditable coverage that is less than six months, the carrier 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.

(d) Except as provided in 11:4-23.1 2, 23.16(d) and in (b) and (c) above, nothing in (a) above shall be construed to prohibit or limit a carrier's use of permissible preexisting condition exclusion provisions in any Medicare supplement policy or certificate as set forth in this subchapter.

N.J. Admin. Code § 11:4-23.9

Amended by R.1993 d.26, effective 1/4/1993.
See: 24 New Jersey Register 12(a), 25 New Jersey Register 141(a).
Rule on filing requirements recodified to 23.12; new rule added on open enrollment.
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.1999 d.161, effective 5/17/1999.
See: 31 New Jersey Register 713(a), 31 New Jersey Register 1336(a).
Inserted new (b) and (c); and recodified former (b) as (d), and inserted "and in (b) and (c) above" following "N.J.A.C. 11:4-23.15(d)".
Amended by R.2005 d.291, effective 9/6/2005. See: 37 New Jersey Register 1428(a), 37 New Jersey Register 3376(a).
In (d), substituted "23.12, 23.16(d)" for "23.15(d)" following "11:4-".