14 Va. Admin. Code § 5-170-95
Current through Register Vol. 40, No. 22, June 17, 2024
Section 14VAC5-170-95 - Persons eligible by reason of disabilityA. An issuer that offers individual Medicare supplement policies shall offer to any individual who resides in this Commonwealth, is younger than 65 years of age, is eligible for Medicare by reason of disability as defined by 42 USC § 426(b) or 42 USC § 426-1, and is enrolled in Medicare Part A and B, or will be so enrolled by the effective date of coverage in accordance with the provisions of § 38.2-3610 of the Code of Virginia, at least one of its Medicare supplement plans that it actively markets to individuals. An issuer that offers Medicare supplement policies on a group basis shall offer to issue a Medicare supplement certificate, for at least one of the Medicare supplement plans issued to the group, to any individual who resides in this Commonwealth, is younger than 65 years of age, is eligible for Medicare by reason of disability as defined by 42 USC § 426(b) or 42 USC § 426-1, is eligible for enrollment in the group policy, and is enrolled in Medicare Part A and B, or will be so enrolled by the effective date of coverage in accordance with the provisions of § 38.2-3610 of the Code of Virginia. The Medicare supplement policy or certificate offered shall be guaranteed renewable. Such Medicare supplement policy or certificate shall be offered and issued during the following enrollment periods:1. Upon the request of the individual during the six-month period beginning with the first month in which the individual is eligible for Medicare by reason of a disability. For those persons who are retroactively enrolled in Medicare Part B due to a retroactive eligibility decision made by the Social Security Administration, the application must be submitted within a six-month period beginning with the month in which the person receives notification of the retroactive eligibility decision; or2. Upon the request of the individual during the 63-day period following voluntary or involuntary termination of coverage under a group health plan.B. For an individual eligible for Medicare by reason of disability under 42 USC § 426-1, the initial enrollment period shall be in accordance with § 38.2-3610 of the Code of Virginia.C. A Medicare supplement policy or certificate issued to an individual under subsection A of this section shall not exclude benefits based on a preexisting condition if the individual has a continuous period of creditable coverage of at least six months as of the effective date of coverage.D. An issuer shall not charge an individual who is younger than 65 years of age and eligible for Medicare by reason of disability as defined by 42 USC § 426(b) or 42 USC § 426-1 a premium rate for any Medicare supplement policy or certificate offered by the issuer that exceeds the premium rate charged for such plan to an individual who is 65 years of age. This requirement applies to any Medicare supplement policy or certificate issued or renewed on or after January 1, 2024.14 Va. Admin. Code § 5-170-95
Adopted, Virginia Register Volume 37, Issue 03, eff. 11/1/2020; Amended, Virginia Register Volume 40, Issue 14, eff. 4/1/2024.Statutory Authority: §§ 12.1-13 and 38.2-223 of the Code of Virginia.