Florida Regulations 69O-156.009: Open Enrollment
Current as of: 2024 | Check for updates
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(1) No issuer shall deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of such a policy or certificate 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 individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate currently available from an insurer shall be made available to all applicants who qualify under this rule without regard to age.
(2)(a) If an applicant qualifies under subsection (1) and submits an application during the time period referenced in subsection (1) and, as of the date of application, has had a continuous period of creditable coverage of at least six (6) months, the issuer shall not exclude benefits based on a pre-existing condition.
(b) If the applicant qualifies under subsection (1) and submits an application during the time period referenced in subsection (1) and, as of the date of application, has had a continuous period of creditable coverage that is less than six (6) months, the issuer shall reduce the period of any pre-existing condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subsection.
(3) Subsections 69O-156.009(1) and 69O-156.019(1), F.A.C., shall not be construed as preventing the exclusion of benefits under a policy, during the first six (6) months, based on a preexisting condition for which the policyholder or certificateholder received treatment or was otherwise diagnosed during the six (6) months before it became effective.
Rulemaking Authority 624.308, 627.674(2) FS. Law Implemented 624.307(1), 627.647(3), 627.6741, 627.6746 FS. History-New 1-1-92, Amended 7-14-96, 7-26-99, Formerly 4-156.009.
(2)(a) If an applicant qualifies under subsection (1) and submits an application during the time period referenced in subsection (1) and, as of the date of application, has had a continuous period of creditable coverage of at least six (6) months, the issuer shall not exclude benefits based on a pre-existing condition.
(b) If the applicant qualifies under subsection (1) and submits an application during the time period referenced in subsection (1) and, as of the date of application, has had a continuous period of creditable coverage that is less than six (6) months, the issuer shall reduce the period of any pre-existing condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subsection.
(3) Subsections 69O-156.009(1) and 69O-156.019(1), F.A.C., shall not be construed as preventing the exclusion of benefits under a policy, during the first six (6) months, based on a preexisting condition for which the policyholder or certificateholder received treatment or was otherwise diagnosed during the six (6) months before it became effective.
Rulemaking Authority 624.308, 627.674(2) FS. Law Implemented 624.307(1), 627.647(3), 627.6741, 627.6746 FS. History-New 1-1-92, Amended 7-14-96, 7-26-99, Formerly 4-156.009.