Title 3 . Commerce, Community, and Economic Development

Chapter 28 . Miscellaneous

Section 472. Filing and approval of policies, certificates, and premium rates

3 AAC 28.472. Filing and approval of policies, certificates, and premium rates

(a) An issuer may not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy or certificate form has been filed with and approved by the director.

(b) An issuer may not use or change premium rates for a medicare supplement policy or certificate unless the rates, rating schedule, and supporting documentation have been filed with and approved by the director.

(c) An issuer may not file for approval more than one form of a policy or certificate of each type for each standard medicare supplement benefit plan except that with the approval of the director, an issuer may offer up to four additional policy forms or certificate forms of the same type for the same standard medicare supplement benefit plan, one for each of the following:

(1) the inclusion of new or innovative benefits;

(2) the addition of either direct response or agent marketing methods;

(3) the addition of either guaranteed issue or underwritten coverage; and

(4) the offering of coverage to individuals eligible for medicare by reason of disability.

(d) For purposes of this section, a "type" means an individual policy, a group policy, an individual medicare select policy, or a group medicare select policy.

(e) Except as provided in (f) of this section, an issuer shall continue to make available for purchase any policy or certificate form issued after 7/1/92 that has been approved by the director. A policy or certificate form must be considered to be available for purchase if the issuer has actively offered it for sale in this state in the previous 12 months.

(f) An issuer may discontinue the availability of a policy or certificate form if the issuer provides to the director in writing its decision at least 30 days before discontinuing the availability of the form of the policy or certificate. After receipt by the director of the notice, the issuer may no longer offer for sale the policy or certificate form in this state.

(g) An issuer that discontinues the availability of a policy or certificate form under (f) of this section may not file for approval a new policy or certificate form of the same type for the same standard medicare supplement benefit plan as the discontinued form for a period of five years after the issuer provides notice of the discontinuance to the director. The period of discontinuance will, in the director's discretion, be reduced if the director determines that a shorter period is appropriate.

(h) The sale or other transfer of a medicare supplement business to another issuer must be considered a discontinuance for purposes of this section.

(i) A change in the rating structure or methodology must be considered a discontinuance under this section unless the issuer

(1) provides an actuarial memorandum, in a form and manner set by the director, describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates; and

(2) does not subsequently put into effect a change of rates or rating factors that would cause the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change, but the director will, in the director's discretion, approve a change to the differential that is in the public interest.

(j) Except as provided in (k) of this section, the experience of all policy or certificate forms of the same type in a standard medicare supplement benefit plan must be combined for purposes of the refund or credit calculation required under 3 AAC 28.468.

(k) Forms assumed under an assumption reinsurance agreement may not be combined with the experience of other forms for purposes of the refund or credit calculation.

( l ) An issuer shall file with the director any rider or amendment to a policy or certificate issued to a resident in this state deleting outpatient prescription drug benefits.

History: Eff. 7/1/92, Register 122; am 7/12/96, Register 139; am 9/17/2003, Register 167; am 9/4/2005, Register 175

Authority: AS 21.06.090

AS 21.42.130

AS 21.89.060