§5011. Rating restrictions
1. Community rating. This subsection applies to any policy delivered or issued for delivery on or after January 1, 1993. It also applies, as of the first policy or certificate anniversary on or after January 1, 1993, to policies or certificates delivered or issued for delivery in 1992.
A. Rates for policies subject to this subsection may not vary based on age, gender, health status, claims experience, policy duration, industry or occupation. [PL 1991, c. 740, §13 (NEW).]
B. In revising rates for standardized plans, an issuer shall pool all experience for standardized plans under individual policies. Experience may be pooled separately for each standardized plan or experience for similar benefits in different standardized plans may be pooled, including, but not limited to, basing the component of the rate for skilled nursing coinsurance on the pooled experience of all standardized plans that include that benefit. Group plans may be rated separately. A group with credible experience may be rated differently than other groups. [PL 2001, c. 258, Pt. F, §4 (AMD).]
C. An issuer that offers both group and individual plans may not use stricter medical underwriting standards for any group plan than it uses for individual plans. [PL 2001, c. 258, Pt. F, §5 (NEW).]
D. An issuer may not use stricter medical underwriting standards than any affiliated issuer uses for its individual plans. [PL 2001, c. 258, Pt. F, §5 (NEW).]
[PL 2001, c. 258, Pt. F, §§4, 5 (AMD).]
2. Discounts. Issuers that do not vary rates for a standardized plan based on age, gender, health status, claims experience, policy duration, industry or occupation, and that do not refuse issue of that plan to any individual or group based on health status, may provide discounts on that plan to individuals who purchase coverage during their initial period of enrollment in Medicare Part B at or after 65 years of age, subject to approval by the superintendent. The superintendent may adopt rules governing the appropriate use of discounts.
[PL 2003, c. 428, Pt. H, §7 (AMD).]
SECTION HISTORY
PL 1991, c. 740, §13 (NEW). PL 2001, c. 258, §§F4,5 (AMD). PL 2003, c. 428, §H7 (AMD).
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