Rule 20:06:13:17.08 Reinstitution of coverage following loss of eligibility for Medicaid.
20:06:13:17.08. Reinstitution of coverage following loss of
eligibility for Medicaid. If suspension of Medicare supplement coverage
occurs for a period of eligibility for Medicaid and if the policyholder or
certificateholder loses entitlement to Medicaid, the policy or certificate
shall be automatically reinstituted effective as of the date of termination of
entitlement if the policyholder or certificateholder provides notice of loss of
entitlement to Medicaid within 90 days after the date of the loss and pays the
premium attributable to the period, effective as of the date of termination of
Reinstitution of Medicare supplement
coverage must comply with the following requirements:
(1) The coverage may not
provide for any waiting period for treatment of preexisting conditions;
(2) The coverage must be
substantially equivalent to coverage in effect before the date of suspension.
If the suspended policy or certificate provided coverage for outpatient
prescription drugs, reinstitution of the policy or certificate for Medicare
part D enrollees shall be without coverage for outpatient prescription drugs
and shall otherwise provide substantially equivalent coverage to the coverage
in effect before the date of suspension; and
(3) The coverage must
provide for classification of premiums on terms at least as favorable to the
policyholder or certificateholder as the premium classification terms that
would have applied to the policyholder or certificateholder had the coverage
not been suspended. This section applies to 1990 standardized Medicare
supplement benefit plans as well as 2010 standardized Medicare supplement
18 SDR 225, effective July 17, 1992; 31 SDR 214, effective July 6, 2005; 35 SDR
183, effective February 2, 2009.
Authority: SDCL 58-17A-2.
Implemented: SDCL 58-17A-2.
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