Guam § 29103 - Standards for Policy Provisions and Authority to Promulgate

§ 29103. Standards for Policy Provisions and Authority to Promulgate

Regulations.

(a) No Medicare supplement policy or certificate in force in Guam shall

contain benefits that duplicate benefits provided by Medicare.

(b) Notwithstanding any other provision of law, a Medicare supplement

policy or certificate shall not exclude or limit benefits for loss incurred more

than six (6) months from the effective date of coverage because it involved 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 (6) months before the effective date of coverage.

(c) The Commissioner shall adopt 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

applicable laws of Guam. No requirement of the Insurance Code relating to

minimum required policy benefits, other than the minimum standards

contained in this Chapter, shall apply to Medicare supplement policies and

certificates. The standards may cover, but not be limited to:

(1) Terms of renewability;

(2) Initial and subsequent conditions of eligibility;

(3) Non-duplication of coverage;

(4) Probationary periods;

(5) Benefit limitations, exceptions and reductions;

(6) Elimination periods;

(7) Requirements for replacement;

(8) Recurrent conditions; and

(9) Definitions of terms.

(d) The Commissioner shall adopt reasonable regulations to establish

COL9222017

minimum standards for benefits, claims payment, marketing practices and

compensation arrangements and reporting practices, for Medicare

supplement policies and certificates.

(e) The Commissioner may adopt from time to time such reasonable

regulations as are necessary to conform Medicare supplement policies and

certificates to the requirements of Federal law and regulations promulgated

thereunder, including but not limited to:

(1) Requiring refunds or credits if the policies are certificates do

not meet loss ratio requirements;

(2) Establishing a uniform methodology for calculating and

reporting loss ratios;

(3) Assuring public access to policies, premiums and loss ratio

information of issuers of Medicare supplement insurance.

(4) Establishing a process for approving or disapproving policy

forms and certificate forms and proposed premium increases;

(5) Establishing a policy for holding public hearings prior to

approval of premium increases; and

(6) Establishing standards for Medicare Select policies and

certificates.

(f) The Commissioner may adopt 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 to be insured under a

Medicare supplement policy or certificate.