- (a) Limitations and exclusions. Except for permitted preexisting condition clauses as described in 365:10-5-126(b)(1) and 365:10-5-127(b)(1), no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy if such policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.
- (b) Waivers. No Medicare supplement policy or certificate may use waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.
- (c) Duplication of benefits. No Medicare supplement policy or certificate in force in the state shall contain benefits which duplicate benefits provided by Medicare.
(d) Outpatient prescription drugs.
- (1) Subject to sections 365:10-5-126(b)(4),(5), and (7) and 365:10-5-127 (b) (4) and (5), a Medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006 shall be renewed for current policyholders who do not enroll in Part D at the option of the policyholder.
- (2) A Medicare Supplement policy with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.
(3) After December 31, 2005, a Medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in Medicare Part D unless:
- (A) The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a Part D plan and;
- (B) Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.
Added at 9 Ok Reg 2499, eff 6-26-92
Amended at 22 Ok Reg 1954, eff 7-14-05