Colorado § 10-18-103 - Standards for policy provisions - guarantee issue.

§ 10-18-103. Standards for policy provisions - guarantee issue.

(1) No medicare supplement insurance policy, contract, or certificate in force in this state shall contain benefits that duplicate benefits provided by medicare.

(2) The commissioner shall issue reasonable regulations to establish specific standards for policy provisions of medicare supplement policies and certificates. Such standards shall be in addition to and in accordance with all applicable laws under this title. No requirement of this title relating to minimum required policy benefits, other than the minimum standards contained in this article, shall apply to medicare supplement policies. The standards shall include, but need not be limited to:

(a) Terms of renewability which shall provide that the policy cannot be canceled or nonrenewed by the insurer solely on the grounds of deterioration of health or of age;

(b) Initial and subsequent conditions of eligibility, which shall include the guaranteed issue requirements in subsection (5) of this section;

(c) Nonduplication of coverage;

(d) Preexisting conditions;

(e) Benefit limitations, exceptions, and reductions which shall not include those which are more restrictive than those of medicare for any type of care covered under the policy;

(f) Elimination, waiting, or probationary periods;

(g) Recurrent conditions;

(h) Definition of terms, including, but not limited to, accident, sickness, benefit period, hospital, nurse, physician, and skilled nursing facility;

(i) Readability standards;

(j) Continuing care coverage as required by section 10-16-413.5.

(3) The commissioner may issue reasonable regulations that specify prohibited policy provisions not otherwise specifically authorized by statute which, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under a medicare supplement policy.

(4) Notwithstanding any other provision of law of this state to the contrary, a medicare supplement policy may not deny a claim for losses incurred more than six months from the effective date of coverage for a preexisting condition. The policy may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

(5) The guaranteed issue period for a medicare supplement policy shall not be for less than six months after a previous policy has been involuntarily terminated for reasons other than nonpayment of premiums or for fraud or abuse. For purposes of this subsection (5), termination of coverage in the CoverColorado coordination of benefits plan due to the plan's termination is an involuntary termination of a previous policy.

Source: L. 89: Entire article R&RE, p. 499, § 1, effective July 1. L. 99: (2)(j) added, p. 1097, § 2, effective June 1. L. 2008: (2)(b) amended and (5) added, p. 1233, § 2, effective May 27. L. 2013: (5) amended, (HB 13-1115), ch. 338, p. 1972, § 13, effective May 28.

Editor's note: This section is similar to former § 10-18-102 as it existed prior to 1989.