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Montana Administrative Register Notice 6-216 No. 11   06/11/2015    
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BEFORE THE COMMISSIONER OF SECURITIES AND INSURANCE

MONTANA STATE AUDITOR

 

In the matter of the amendment of ARM 6.6.507B, 6.6.507C, 6.6.507E, 6.6.511, and 6.6.511A pertaining to Medicare Supplements

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO: All Concerned Persons

 

1. On July 1, 2015, at 10:00 a.m., the Commissioner of Securities and Insurance, Montana State Auditor, will hold a public hearing in the 2nd floor conference room, at the Office of the Commissioner of Securities and Insurance, Montana State Auditor (CSI), 840 Helena Ave., Helena, Montana, to consider the proposed amendment of the above-stated rules.

 

2. The CSI will make reasonable accommodations for persons with disabilities who wish to participate in this public hearing, or need an alternative accessible format of this notice. If you require an accommodation, contact the CSI no later than 5:00 p.m., June 24, 2015, to advise us of the nature of the accommodation that you need. Please contact Darla Sautter, CSI, 840 Helena Avenue, Helena, Montana, 59601; telephone (406) 444-2726; TDD (406) 444-3246; fax (406) 444-3499; or e-mail dsautter@mt.gov.

 

3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:

 

          6.6.507B OPEN ENROLLMENT (1) through (3) remain the same.

          (4) There shall be a one-time open enrollment from October 15, 2015, to December 7, 2015, for individuals who meet the following criteria:

          (a) the individual became eligible and the individual's enrollment became effective for Medicare Part A and Medicare Part B by reason of disability, prior to October 18, 2013; and

          (b) the individual did not apply for coverage from an issuer, or applied for coverage from an issuer and was denied.

 

          AUTH: 33-1-313, 33-22-904, 33-22-905, MCA

          IMP: 33-22-902, 33-22-904, MCA

 

          6.6.507C GUARANTEED ISSUE FOR ELIGIBLE PERSONS (1) through (2)(g) remain the same.

          (h) the individual, upon first becoming eligible for benefits under Medicare Part A and B is enrolled in the Qualified Medicare Beneficiary Program as defined in section 6408(d)(2) of the Federal Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, or full Medicaid (ARM 37.83.902), and no longer qualifies due to income or eligibility changes; or

          (i)  the individual, upon first becoming eligible for benefits under Medicare Part and B enrolls in the Montana Comprehensive Health Association and coverage under the Montana Comprehensive Health Association terminates; or

          (j) remains the same, but is renumbered (i).

          (3) and (3)(a) remain the same.

          (i) the date the individual receives a notice of termination or cessation of some or all supplemental health benefits provided under an employee welfare benefit plan (or, if a notice is not received, notice that a claim has been denied because of such a termination or cessation); or

          (ii) remains the same.

          (iii) ends 63 days after either the applicable notice or the date that the applicable coverage terminates or ceases when notice is not sent;

          (b)  an individual described in (2)(b), (c), (e), (f), or (h), (i), or (j), whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends 63 days after the date the applicable coverage is terminated;

          (c) through (ii) remain the same.

          (d) an individual described in (2)(b), (d)(ii), (d)(iii), (e), or (f) who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days before the effective date of the disenrollment and ends on the date that is 63 days after the effective date;

          (e)  an individual described in (2)(g), the guaranteed issue period begins on the date the individual receives notice pursuant to section 1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the 60 day period immediately preceding the initial Part D enrollment period and ends on the date that is 63 days after the effective date of the individual's coverage under Medicare Part D; and

          (f) an individual described in (2) but not described in the preceding provisions of the rule, the guaranteed issue period begins on the effective dates of disenrollment and ends on the day that is 63 days after the effective date.; and

          (g)  an individual described in (2)(i), the guaranteed issue period begins on the date the individual is informed of the individual's eligibility for Medicare by reason of disability and ends 63 days after that date.

          (4) through (5)(c)(ii) remain the same.

          (d) an eligible person defined in (2)(f), (h), or (i), or (j) is entitled to the issuance of any Medicare supplement policy offered by any issuer;

          (5)(e) through (6)(b) remain the same.

         

          AUTH: 33-1-313, 33-22-904, 33-22-905, MCA

          IMP: 33-22-902, 33-22-904, 33-22-905, MCA

 

          6.6.507E STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 2010 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED WITH AN EFFECTIVE DATE FOR COVERAGE ON OR AFTER JUNE 1, 2010 (1) through (7)(e)(i) remain the same.

          (ii) 100% of the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, 100% of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country, established in ARM 6.6.507D(4)(b).

          (f) through (11) remain the same.

 

          AUTH: 33-1-313, 33-22-904, 33-22-905, MCA

          IMP: 33-15-303, 33-22-901, 33-22-902, 33-22-903, 33-22-904, 33-22-905, 33-22-909, 33-22-910, 33-22-911, 33-22-921, 33-22-922, 33-22-923, 33-22-924, MCA

 

          6.6.511 SAMPLE FORMS OUTLINING COVERAGE (1) The following amounts, as published in the Federal Register, for services furnished in the current calendar year under Medicare's hospital insurance program (Medicare Part A), must apply to the charts for 1990 Plans A through L for policies issued prior to June 2010 in (2)(b) through (m). In each chart, the rule cited in brackets as ARM [6.6.511(1)(a)], [6.6.511(1)(b)], [6.6.511(1)(c)], [6.6.511(1)(d)], [6.6.511(1)(e)], [6.6.511(1)(f)], [6.6.511(1)(g)], [6.6.511(1)(h)], [6.6.511(1)(i)], or [6.6.511(1)(j)], represents the dollar amount specified in the cited rule subsection. The issuer must replace each bracket and rule cite with the correct dollar amount contained in the cited rule subsection when the issuer prints the charts:

          (a) inpatient hospital deductible = $1068.00;

          (b) benefit period = $267.00;

          (c) daily coinsurance amount for the 61st through 90th days of hospitalization in a coinsurance amount for lifetime reserve days = $534.00;

          (d) daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $133.50;

          (e) 50% of inpatient hospital deductible = $534.00;

          (f) 75% of inpatient hospital deductible = $801.00;

          (g) 25% of inpatient hospital deductible = $267.00;

          (h) 50% of daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $66.75;

          (i) 75% of daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $100.13; and

          (j) 25% of daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $33.38.

          (2) The following are sample forms of the outline of coverage for Medicare supplement policies.

          (3) remains the same, but is renumbered (1).

 

          AUTH: 33-1-313, 33-22-904, MCA

          IMP: 33-15-303, 33-22-901, 33-22-902, 33-22-903, 33-22-904, 33-22-905, 33-22-906, 33-22-907, 33-22-908, 33-22-909, 33-22-910, 33-22-911, 33-22-921, 33-22-922, 33-22-923, 33-22-924, MCA

 

          6.6.511A SAMPLE FORMS OUTLINING COVERAGE (1) The following amounts, as published in the Federal Register, for services furnished in the current calendar year under Medicare's hospital insurance program (Medicare Part A), must apply to the charts for Plans A, B, C, D, F, and High Deductible Plan F, G, K, L, M, and N, issued on or after June 1, 2010, in (2)(b) through (m). In each chart, the rule cited in brackets as ARM [6.6.511A(1)(a)], [6.6.511A(1)(b)], [6.6.511A(1)(c)], [6.6.511A(1)(d)], [6.6.511A(1)(e)], [6.6.511A(1)(f)], [6.6.511A(1)(g)], [6.6.511A(1)(h)], [6.6.511A(1)(i)], or [6.6.511A(1)(j)], represents the dollar amount specified in the cited rule subsection. The issuer must replace each bracket and rule cite with the correct dollar amount contained in the cited rule subsection when the issuer prints the charts:

(a) inpatient hospital deductible = $1068.00;

(b) daily coinsurance amount for the 61st through 90th days of hospitalization in a benefit period = $267.00;

(c) daily coinsurance amount for lifetime reserve days = $534.00;

(d) daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $133.50;

(e) 50% of inpatient hospital deductible = $534.00;

(f) 75% of inpatient hospital deductible = $801.00;

(g) 25% of inpatient hospital deductible = $267.00;

(h) 50% of daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $66.75;

(i) 75% of daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $100.13; and

(j) 25% of daily coinsurance amount for the 21st through 100th days of extended care services in a skilled nursing facility in a benefit period = $33.38.

          (2) The following are sample forms of the outline of coverage for Medicare supplement policies:

          (3) remains the same but is renumbered (1).

 

          AUTH: 33-1-313, 33-22-904, MCA

          IMP: 33-15-303, 33-22-901, 33-22-902, 33-22-903, 33-22-904, 33-22-905, 33-22-906, 33-22-907, 33-22-908, 33-22-909, 33-22-910, 33-22-911, 33-22-921, 33-22-922, 33-22-924, MCA

 

          4. STATEMENT OF REASONABLE NECESSITY: The Commissioner of Securities and Insurance, Montana State Auditor, Monica J. Lindeen, (commissioner) is the statewide elected official responsible for administering the Montana Insurance Code and regulating the business of insurance.

 

The Commissioner is a member, and President of the National Association of Insurance Commissioners (NAIC). The NAIC is an organization of insurance regulators from the 50 states, the District of Columbia, and the U.S. Territories. The NAIC provides a forum for the development of uniform policy and regulation when uniformity is appropriate.

 

The additional subsection to ARM 6.6.507B is reasonably necessary because the 2013 amendments to the Open Enrollment period created a donut hole wherein persons of the same class (on Medicare because of disability) were treated disparately depending on when Medicare recognized their disability. This gives all persons who did not, or could not, obtain coverage previously a one-time opportunity to receive benefits that those who became eligible for Medicare after the rule update would receive. The rule intentionally excludes persons who obtained coverage but then dropped it. The date period is set to coincide with the open enrollment period for Medicare set by CMS.

 

Changes to ARM 6.6.508(2), (3)(b), and (4)(d) are reasonably necessary because (2)(i) applies to individuals formerly covered under the Montana Comprehensive Health Association, which no longer exists. These subsections were modified to eliminate obsolete references to this program.

 

The change to ARM 6.6.507C(3)(a)(i) is reasonably necessary because (2)(a) and (3)(a) allow for guaranteed issue where existing group coverage ceases, whether or not the coverage is supplemental or primary to the group coverage. The rule amendment makes (3)(a)(i) consistent with those subsections. Similarly, adding the term "employee welfare benefit plan" is reasonably necessary to clarify what type of coverage is being addressed.

 

The change to ARM 6.6.507C(3)(a)(iii) is reasonably necessary to provide a time period for ending guaranteed issue periods when notice has not been sent out by the carrier.

 

A second change to ARM 6.6.507C(3)(b) is reasonably necessary because the reference to the former (2)(j) is inaccurate. Subsection (3)(b) refers to involuntary termination of coverage, whereas (2)(j) contemplates eligibility by reason of disability - not involuntary termination. Therefore, this errant reference to (2)(j) was eliminated and (3)(g) was also created to address eligibility by reason of disability under the former (2)(j) now (2)(i). 

 

The change to ARM 6.6.507C(3)(d) is reasonably necessary because the reference to (2)(d)(ii) is inaccurate. That section refers to an involuntary termination of coverage, whereas (3)(d) discusses what happens when there is a voluntary cessation of coverage.

 

The change to ARM 6.6.507E(7)(e)(ii) is reasonably necessary so that the High Deductible Plan F and Regular Plan F charges are identical for Medicare Part A and Medicare Part B. The language is already present in the High Deductible Plan F, so that subsection does not need to be changed. This is also consistent with the NAIC model rules.

 

The changes to ARM 6.6.511 and 6.6.511A striking the language of the sample forms are reasonably necessary because the adoption of the NAIC model act regarding payment tables obviates the need for the sample forms addressing those same tables. Persons needing payment tables can obtain the information from the NAIC's model rules.

 

          5. Concerned persons may submit their data, views, or arguments concerning the proposed actions either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to Brett O'Neil, Attorney, Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-2040; fax (406) 444-3499; or e-mail bo'neil@mt.gov, and must be received no later than 5:00 p.m., July 9, 2015.

 

          6. Brett O'Neil, Attorney, has been designated to preside over and conduct this hearing.

 

          7. The CSI maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Such written request may be mailed or delivered to Darla Sautter, Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-2726; fax (406) 444-3499; or e-mail dsautter@mt.gov, or may be made by completing a request form at any rules hearing held by the CSI.

 

          8. An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods due to system maintenance or technical problems.

 

          9. Pursuant to 2-4-302, MCA, the bill sponsor contact requirements do not apply.

 

          10. The proposed rule amendments do not significantly and directly impact small businesses; therefore, the requirements of 2-4-111, MCA, do not apply.

 

          /s/ Nick Mazanec                         /s/ Jesse Laslovich          

          Nick Mazanec                              Jesse Laslovich

          Rule Reviewer                             Chief Legal Counsel

         

Certified to the Secretary of State June 1, 2015.

 

         

 

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