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OIR RECOGNIZES MEDICARE SUPPLEMENT POLICIES WITH NEW OR INNOVATIVE BENEFITS

OIR RECOGNIZES MEDICARE SUPPLEMENT POLICIES WITH NEW OR INNOVATIVE BENEFITS

OIR has issued a new Informational Memorandum #OIR-15-06M, entitled “Medicare Supplement Policies in Florida.” In the Memorandum, OIR reviews the filing requirements for a Medicare Supplement policy, but also informs insurers of additional options available for products in this marketplace.

Under section 627.672, F.S., a “Medicare supplement policy” is defined as “a health insurance policy or other health benefit plan offered by a private entity to individuals who are entitled to have payments for health care costs made under Medicare, Title XVIII of the Social Security Act (“Medicare”), … which provides reimbursement for expenses incurred for services and items for which payment may be made under Medicare but which expenses are not reimbursable by reason of the applicability of deductibles, coinsurance amounts, or other limitations imposed by Medicare.”  A policy does not need to be called a “Medicare supplement policy” for Part VIII of Chapter 627 to apply. Also, Medicare supplement policies in Florida must provide for the minimum standards outlined in Part VIII and in Rule Chapter 69O-156, F.A.C.

However, under Florida law, a Medicare supplement policy can provide additional benefits which are not inconsistent with those minimum standards. Rule 69O-156.0085(6) provides:

(6) New or Innovative Benefits: An issuer may, with the prior approval of the Office, offer policies or certificates with new or innovative benefits, in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits shall include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective. Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification. New or innovative benefits shall not include an outpatient prescription drug benefit. New or innovative benefits shall not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan.

Additionally, OIR reminds insurers that the out-of-state group exemption in section 627.6515, F.S., does not apply to Medicare supplement insurance policies.   Out-of-state group policies that provide Medicare supplement benefits to Florida residents must be filed with the Office for approval.