11 NCAC 12 .0843             NAIC MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS MODEL ACT

(a)  The North Carolina Department of Insurance incorporates by reference, including subsequent amendments and editions, the National Association of Insurance Commissioners Medicare Supplement Insurance Minimum Standards Model Act, Model No. 651.  Copies of this Act may be obtained from:  The National Association of Insurance Commissioners, 2301 McGee Street, Kansas City, MO 64108-1662; the North Carolina Department of Insurance, Life & Health Division, 1201 Mail Service Center, Raleigh, NC 27699-1201; and from the Department of Insurance web page:  http://www.ncdoi.com/.

(b)  Section 7 of Model No. 651 shall apply to policies or certificates issued for delivery in North Carolina before January 1, 1992.

(c)  Section 8 of Model No. 651 shall apply to policies or certificates issued for delivery in North Carolina on or after January 1, 1992.

(d)  For purposes of this rule, Section 8A(7)(c) of Model No. 651 shall read as follows:

Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under Section 226(b) of the Social Security Act and is covered under a group health plan (as defined in Section 1862(b)(1)(A)(v) of the Social Security Act).  If suspension occurs and if the policyholder or certificate holder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage 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 enrollment in the group health plan.

(e)  The applicable effective dates for Section 14B(3) of Model No. 651 are October 16, 1991, December 1, 1995, and May 31, 1997.

(f)  Insurers shall use the Appendices of Model No. 651 for reporting and disclosure formats.

(g)  This Rule applies to policies issued, renewed, or reinstated on or after January 1, 2006.

 

History Note:        Authority G.S. 58-2-40; 58-54-10; 58-54-15; 58-54-25; 58-54-50;

Eff. August 1, 2005.