Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act

What this document is

Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act is a naic model law published by National Association of Insurance Commissioners (NAIC). It is one of the documents that insurance license exam questions are written from, including life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• NAIC Model #651: Appendix C (Disclosure Statements)

  “State and federal law prohibits insurers from selling a Medicare supplement policy to a person that already has a Medicare supplement policy except as a replacement policy.”

• NAIC Model #651: Section 11 (Open Enrollment)

  “because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted prior to or during the six (6) month period beginning with the first day of the first month in which an...”

• NAIC Model NAIC 651, Section 21 (Appropriateness of Recommended Purchase and Excessive Insurance)

  “Any sale of a Medicare supplement policy or certificate that will provide an individual more than one Medicare supplement policy or certificate is prohibited.”

• NAIC Model NAIC 651: Appendix C (Disclosure Statements Instructions)

  “Section 1882 (d) of the federal Social Security Act [42 U.S.C. 1395ss] prohibits the sale of a health insurance policy (the term policy includes certificate) to Medicare beneficiaries that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary’s other health...”

• NAIC Model NAIC 651: Section 24 (Prohibition Against Use of Genetic Information)

  “An issuer of a Medicare supplement policy or certificate shall not request or require an individual or a family member of such individual to undergo a genetic test.”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation § 23.A (prohibition against preexisting conditions and waiting periods in replacement policies)

  “If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new Medicare supplement policy or...”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation § 8.1B(3): coverage upon exhaustion of Medicare hospital inpatient coverage

  “Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard...”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation § 6B: prohibited use of waivers

  “No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation § 8.1C(6) (medically necessary emergency care in a foreign country)

  “Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care...”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation § 8.1C(3) (skilled nursing facility care additional benefit)

  “Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for posthospital skilled nursing facility care eligible under Medicare Part A.”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation (#651) § 10G (Medicare Select Policies and Certificates)

  “A Medicare Select policy or certificate shall not restrict payment for covered services provided by non-network providers if: (1) The services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition; and (2) It is not reasonable to...”

• NAIC Medicare Supplement Insurance Minimum Standards Model Regulation (#651) § 10H (Medicare Select Policies and Certificates)

  “A Medicare Select policy or certificate shall provide payment for full coverage under the policy for covered services that are not available through network providers.”

Practice this material

Questions about this source

More NAIC model laws sources

• Health Carrier Prescription Drug Benefit Management Model ActNAIC model law
• INDIVIDUAL MARKET HEALTH INSURANCE COVERAGE MODEL REGULATIONNAIC model law
• INDIVIDUAL MARKET HEALTH INSURANCE COVERAGE MODEL ACTNAIC model law
• Advertisements of Accident and Sickness Insurance Model RegulationNAIC model law
• Health Information Privacy Model ActNAIC model law
• Health Benefit Plan Network Access and Adequacy Model ActNAIC model law
• Health Carrier External Review Model ActNAIC model law
• MODEL HEALTH PLAN FOR UNINSURABLE INDIVIDUALS ACTNAIC model law