14 Va. Admin. Code § 5-160-70

Current through Register Vol. 40, No. 22, June 17, 2024

Section 14VAC5-160-70 - Offer of reinstitution of coverage

A. Except as provided in subsection B, in the case of an individual who had in effect, as of December 31, 1988, a Medicare supplement policy with an insurer, as a policyholder or, in the case of a group policy, as a certificate holder, and the individual terminated coverage under such policy before the date of the enactment of the repeal of the Medicare Catastrophic Coverage Act of 1988 ( Public Law 100-360, 102 Stat. 683 (July 1, 1988) 42 USC § 1305 ), the insurer shall:

1. Provide written notice no earlier than December 15, 1989, and no later than January 30, 1990, to the policyholder or certificate holder at the most recent available address, of the offer described below, and

2. Offer the individual, during a period of at least 60 days beginning not later than February 1, 1990, reinstitution of coverage, with coverage effective as of January 1, 1990, under terms which:

a. Do not provide for any waiting period with respect to treatment of pre-existing conditions;

b. Provide for coverage which is substantially equivalent to coverage in effect before the date of such termination; and

c. Provide for classification of premiums on which terms are at least as favorable to the policyholder or certificate holder as the premium classification terms that would have applied to the policyholder or certificate holder had the coverage never terminated.

B. An insurer is not required to make the offer under subdivision 2 above in the case of an individual who is a policyholder or certificate holder in another Medicare supplement policy as of January 1, 1990, if the individual is not subject to a waiting period with respect to treatment of a preexisting condition under such other policy.

14 Va. Admin. Code § 5-160-70

Derived from Regulation 36, Case No. INS900003, § 8, eff. January 31, 1990.

Statutory Authority

§§ 38.2-223, 38.2-3516 through 38.2-3520, 38.2-3600 through 38.2-3609, 38.2-4214, 38.2-4215 and 38.2-514 of the Code of Virginia.