1. (1)(a) An issuer may not deny or condition the issuance or effectiveness of a policy or certificate available for sale in this state, nor discriminate in the pricing of 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 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.

   1. (b) Each policy or certificate currently available from an issuer shall be available to an applicant who qualifies under this section regardless of age.
   2. (c) During an applicant's open enrollment period, an issuer shall offer the lowest rate available to an applicant without regard to health or smoker status.

2. (2)(a) An issuer may not exclude benefits based on a preexisting condition if an applicant described in Subsection (1) has had a continuous period of creditable coverage of at least six months.

   1. (b) An issuer shall reduce the period of a preexisting condition exclusion by the aggregate of the period of creditable coverage if an applicant, described in Subsection (1), as of the date of application, has had a continuous period of creditable coverage that is less than six months. The Secretary shall specify the manner of the reduction under this subsection.
3. (3) Except as provided in Subsection (2) and Sections R590-146-12 and R590-146-13, Subsection (1) may not be construed as preventing the exclusion of benefits under a policy, during the first six months, for a preexisting condition.

4. (4)(a) An issuer shall offer an insured an annual election period that begins on the insured's birthday and ends 60 days later.

   1. (b) During the annual election period, an issuer:

      1. (i) shall offer to an existing insured each standardized plan the issuer currently offers for which benefits are considered equal to or less than the insured's current benefits, not including any innovative benefits;
      2. (ii) may revise an insured's premium, in the same rating class, based on the insured's newly selected standardized plan; and

      3. (iii) may not:

         1. (A) underwrite or perform any activity that increases the insured's premium based on the insured's health status;
         2. (B) impose a new benefit exclusion or exclusion period based on a preexisting condition; or
         3. (C) discriminate in the pricing of the new plan because of health status, claims experience, receipt of health care, or medical condition.
   2. (c) An issuer is not required to offer to an insured during the annual election period a standardized plan that is available through the issuer's affiliate.

   3. (d) This Subsection (4):

      1. (i) applies to an insured annually on each birthday after May 6, 2025; and
      2. (ii) does not apply to an insured who is not currently insured in a Medicare supplement insurance policy with the issuer.

KEY: insurance

Date of Last Change: September 29, 2025

Notice of Continuation: April 1, 2022

Authorizing, and Implemented or Interpreted Law: 31A-22-620