Details for 3772376.pdf

EMERGENCY ORDER REPEALING, RENUMBERING,
RENUMBERING AND AMENDING,
AMENDING, REPEALING AND RECREATING AND
CREATING A RULE
Office of the Commissioner of Insurance
Rule No. Agency 145 – INS 3.39 and 3.55, Wis. Adm. Code,
proposes an order to repeal INS 3.39 (1) (c), (2) (a) 4., (c) 1.
and (d) 4., (3) (r) 1. to 3., (4) (a) 18r. (intro.), (4s) (a) 21. (intro.),
(15) (Note), (30) (b), (30m) (b), (31) (bm), Appendices 8 and 9; to
renumber and amend INS 3.39 (3) (r) (intro.), (4) (a) 18r. a. to c.,
(4m), (4s) (intro.), (a) (intro.) and 1. to 20., 21. a. to c., 22., and (b)
to (f), (5m) (a) 1., (b) and (c), (14m) (d) (intro.) and 1. to 3., (16)
(d) 3., (34) (ez), Appendix 2 to Appendix 5, INS 3.55 (d) and (e);
to consolidate, renumber and amend INS 3.39 (2) (c) (intro.)
and 2.; to amend INS 3.13 (2) (j) (intro.), 3. and (Note), INS 3.29
(3) (a) and (7) (b), INS 3.39 (1) (a), (b), and (d), (2) (a) (intro.) 1.
to 3., 5., and (b), (d) (intro.), (e) (intro.) and 1., (3) (c) (intro.) and
1., (ce), (e) to (g), (i) 1. c., d. and 5. a., (v), (w), (y), (za) and (zb),
(4) (title), (intro.), (a) (intro.) 1. to 7., 9. to 12., and 16., 18. and
18p., (b) (intro.) and 1. to 7., (c), (e), and (g), (5) (title), (intro.),
(c) (intro.), (n) 12., (o) 12., (5m) (title), (a) 2. (intro.), (e), (g) 12.,
(h) 12., and (k) 4., (6) (intro.), (7) (title), (a) (intro.), (b) (intro.), 1.
(intro.), c. and 2., (c), (cm) and (dm), (8) (title), (a) (intro.), (c), and
(e), (10) (title), (a) and (d) 1., (13), (14) (a), (c) (intro.) 1. to 6., (d),
(i) and (L), (14m) (title), (a), (c) 1. to 6., and (i) (intro.), (15), (16)
(a), (c), (d) (intro.), 1., and (e), (17), (21) (a), (22) (d), (f) (intro.),
and 1., (23) (a) (intro.), (c) and (e), (24) (a) (intro.) and 3., (25) (a)
to (c); (26) (a) (intro.),1., and (b), (27), (28) (title), (a) (intro.), (b) 2.
and (c), (29) (a) and (b) 1., (30) (a), (k) (intro.), (n) (intro.), (q) 12.
and (r) 12., (30m) (a) 1., (i) 1. (intro.) and 8., (k) (intro.), (n) (intro.),
(q) (intro.), (r) 12, (s) 12., (34) (a) 1., 2., (b) (intro.), 1s. and 2., (e)
4. and 5., (f) 1. and 2., (35) (intro.) and (a), Appendix 1, Appendix
6 and 7, INS 3.55 (title) (1), (2), (4) (a) and (5) (intro.), INS 9.01
(3m); to repeal and recreate INS 3.39 (31) (a) and (b); to create
INS 3.39 (3) (fm), (gm), (jm), (pm), (um), (ve), (vm), (vs), (we),
(wm), (ws), (zag), (zar), (zbm), and (zcm), (3g), (4t), (5m) (a)
(intro.), (a) 1. b., (5t), (7) (ct) and (dt), (14t), (16) (d) 3. a. to g.,
(21) (f), (24) (a) 4., (26) (a) 3. to 6., (30t), (34) (et), Appendices
2t, 3t, 4t, 5t, 6m, and 6t, Wis. Adm. Code, relating to Medicare
supplement insurance regulations and reporting requirements
and affecting small business.
The statement of scope for this emergency rule SS: 095-19,
was approved by the Governor on August 29, 2019, published in
Register No. 765A2 on September 9, 2019, and was approved by
the Commissioner on September 24, 2019. The emergency rule
was approved by the Governor on October 10, 2019 to submit
for publication.
In addition to the emergency rule, the office issued a
permanent rule for sections Ins 3.39 and 3.55, Wis. Adm. Code,
CHR 19-036 that was submitted to the legislature on August 12,
2019.
FINDING OF EMERGENCY
The Commissioner of Insurance finds that an emergency
exists and that the proposed emergency rule is necessary for
the immediate preservation of the public peace, health, safety, or
welfare. Facts constituting the emergency are as follows:
Sections Ins 3.39 and 3.55, Wis. Adm. Code, establishes
regulations and requirements for Medicare supplemental
insurance and long-term care products. The Centers for Medicare
& Medicaid Services (CMS) required the National Association of
Insurance Commissioners, (NAIC) to make conforming changes
to the Medicare supplement model regulation by incorporating
changes to implement the federal Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA), P.L. 114-10. States are
required to adopt the NAIC model revision by or before January
1, 2020 in order to continue regulating the Medicare supplement
marketplace. This emergency rule will ensure the State of
Wisconsin is in compliance with the 2020 MACRA requirements
and have compliant Medicare supplemental products available to
Wisconsin consumers during the 2020 open enrollment period
from October 15 through December 7, 2019.
ANALYSIS PREPARED BY THE OFFICE OF THE
COMMISSIONER OF INSURANCE (OCI)
1. Statutes interpreted:
ss. 185.983 (1m), 600.03, 601.01 (2), 609.01 (1g) (b), 625.16,
628.34 (12), 628.38, 631.20 (2), 632.73 (2m), 632.76 (2) (b) and
632.81, 632.84, 632.895 (2), (3), (4), and (6), Wis. Stats.
2. Statutory authority:
ss. 601.41 (3), 625.16, 628.34 (12), 628.38, 632.73 (2m) and
(3) (b), 632.76 (2) (b), 632.81, Wis. Stats.
3. Explanation of OCI’s authority to promulgate the
proposed rule under these statutes:
The statutes all relate to the commissioner’s authority to
promulgate rules regulating the business of insurance as it relates
to Medicare supplement and Medicare replacement insurance
products. Specifically, ss. 601.41 (3), 625.16, 628.38, 632.73 (2m)
and (3) (b), 632.76 (2) (b), and 632.81, Wis. Stats., permit the
commissioner to promulgate rules regulating various aspects of
Medicare supplement and Medicare replacement products while
ss. 628.34, and 628.38, Wis. Stats., authorize the commissioner
to promulgate rules governing disclosure requirements and unfair
marketing practices for disability policies that includes Medicare
supplement and Medicare replacement products.
4. Related statutes or rules:
The Centers for Medicare & Medicaid Services (CMS)
required the National Association of Insurance Commissioners,
(NAIC) to make conforming changes to the Medicare supplement
model regulation by incorporating changes to implement the
federal Medicare Access and CHIP Reauthorization Act of 2015
(MACRA), P.L. 114-10. States are required to adopt the NAIC
model revision in order to continue regulating the Medicare
supplement marketplace.
CMS delegates enforcement of MACRA to the states that
have incorporated the NAIC model into states insurance laws
or regulations. To date Wisconsin has passed NAIC model
regulations through statutes and regulations governing Medicare
supplement and Medicare replacement products. In Wisconsin
Medicare supplement and Medicare replacement products are
currently regulated under s. Ins 3.39, Wis. Adm. Code, inclusive
of the appendices that this proposed rule modifies to implement
MACRA requirements.
5. The plain language analysis and summary of the
proposed rule:
The proposed rule amends the current rules to incorporate the
NAIC model regulation that implements the Medicare Supplement
Insurance Minimum Standards Model Act to comply with MACRA.
Medicare supplement policies are policies purchased by Medicare
beneficiaries to cover Medicare deductibles, co-insurance
and selected services that Medicare does not cover. Medicare
establishes eligibility rules, benefits and coverage limits.
The proposed rule implements changes to the Medicare
supplement benefits that are permitted to be offered to persons
newly eligible for Medicare on or after January 1, 2020. Wisconsin
is a waived state, meaning Wisconsin is waived from implementing
the standardized Medicare supplement Plans A to N, and instead
requires minimum standardized supplemental benefits with
seven standardized benefit riders. This is advantageous to both
the insurer and the consumers as this system permits consumers
to compare products on an equal basis to determine the best
product to meet their insurance needs. However, beginning with
January 1, 2020, consumers who are first eligible for Medicare on
or after January 1, 2020, may not be offered the Medicare Part
B deductible in accordance with MACRA. This change does not
affect those who became eligible for Medicare prior to January 1,
2020, through age or disability, including end-stage renal disease.
This change also does not limit the ability for insurers to continue
to market and offer the Medicare Part B deductible to consumers
first eligible for Medicare prior to January 1, 2020.
The remainder of the proposed rule; updates terminology,
creates consistency in numbering and references, and updates
and simplifies the appendices to the rule. However, since
Medicare supplement and Medicare select plans are guaranteed
renewable for life, OCI cannot repeal original or previous federal
law changes reflected in the current regulation as individuals may
still have existing policies regulated under those sections. Instead
OCI, in this draft, adopts a parallel citation approach for ease of
navigation. Subsections that apply to all plans or a plan issued to
groups or individuals who were first eligible for Medicare prior to
June 1, 2010, appear with just a number for the subsection, i.e.
s. Ins 3.39 (4), Wis. Adm. Code. All appendices and subsections
that apply to policies issued to groups or individuals who were
first eligible for Medicare on or after June 1, 2010, and prior to
January 1, 2020, appear as a number with the letter “m” following
the subsection number, i.e. s. Ins 3.39 (4m), Wis. Adm. Code.
For the new plans that will be issued to groups or individuals who
are newly eligible for Medicare on or after January 1, 2020, all
appendices and subsections appear as a number with the letter
“t” following the subsection number, i.e. s. Ins 3.39 (4t), Wis.
Adm. Code. Finally, there are citation corrections within cross
references to existing or newly created s. Ins 3.39, Wis. Adm.
Code, provisions within the insurance administrative code.
6. Summary of and preliminary comparison with any
existing or proposed federal regulation that is intended
to address the activities to be regulated by the proposed
rule:
This proposed rule will permit Wisconsin to continue to have
jurisdiction and control over Medicare supplement, select and
cost products offered in this state. Wisconsin is a waived state
so Wisconsin consumers are not subjected to the federal plan
listings typically associated with Medicare supplemental plans
that are enumerated by letters that frequently change. Further,
Wisconsin developed a standardized set of basic coverage
inclusive of applicable mandates and a finite number of riders
prior to 1990. This approach allows consumers to easily compare
“apple to apple” coverage and options available for their
supplemental needs.
7. Summary of any public comments and feedback on the
statement of scope of the proposed rule that the agency
received at any preliminary public hearing and comment
period held under s. 227.136, Stat., and a description of
how and to what extent the agency took those comments
and that feedback into account in drafting the proposed
rule.
The office gave notice of a preliminary public hearing on a
statement of scope for s. Ins 3.39 and 3.55, Wis. Adm. Code,
relating to amending Medicare supplemental insurance and
reporting requirements. The notice was published in the
Wisconsin Administrative Register on July 30, 2018, in Register
No. 751B. A public hearing was held on August 9, 2018 at 11:00
am. Notice as also published on the office’s website. The public
could provide oral or written testimony and a public comment
period was open until 4:00 pm on August 20, 2018.
Testimony was received by OCI that addressed areas of
potential confusion between the NAIC model and the federal
MACRA law. Specifically, testimony highlighted that the key
decision point for what coverage a person who is Medicare eligible
may receive through a Medicare supplemental product is tied to
the date the individual first became eligible for Medicare. The
testimony provided highlighted that although MACRA required
insurers to not offer the Medicare Part B medical deductible rider
to persons first eligible for Medicare on or after January 1, 2020,
insurers could continue offering the rider to persons eligible for
Medicare prior to January 1, 2020. Additionally, it was noted that
given Medicare supplemental products are guaranteed renewable
for life thus necessitating insurers to continue to renew the
Medicare Part B medical deductible rider coverage. The office, in
drafting the permanent rule, incorporated the suggestions raised
in oral testimony into the drafted rule.
8. Com0 OCI:
Illinois: 50 Ill. Adm. Code 2008, Minimum Standards for
Individual and Group Medicare Supplement Insurance. Effective
November 26, 2018. Please note that as Wisconsin is a waived
state for Medicare supplemental insurance there are no similar
rules in adjacent states.
Iowa: IA ADC 191-37 (514D). Effective May 15, 2019
implementing MACRA. Please note that as Wisconsin is a waived
state for Medicare supplemental insurance there are no similar
rules in adjacent states.
Michigan: M.C.L.A 500.3801-3861. Effective March 20, 2019.
Please note that as Wisconsin is a waived state for Medicare
supplemental insurance there are no similar rules in adjacent
states.
Minnesota: Minnesota Statutes s. 62A.3099 to 62A.44 are
being revised by 2019 Legislative Bill HF2051 and SF2313. The
proposed bills will implement the MACRA changes. Please note
that as Wisconsin is a waived state for Medicare supplemental
insurance there are no similar rules in adjacent states.
9. A summary of the factual data and analytical
methodologies that OCI used in support of the proposed
rule and how any related findings support the regulatory
approach chosen for the proposed rule:
OCI’s review of complaints, NAIC models, insurer’s financial
information, and CMS data indicates that Medicare currently
covers 60 million Americans, 1,143,459 of whom are Wisconsin
residents as of 2018. An estimated 25 percent of Wisconsin
Medicare beneficiaries are covered by Medicare supplement
policies. Nationally, the per person personal health care spending
for the 65 and older population was $18,988 in 2012.
Information collected by the OCI indicates that 48 insurance
companies offer Medicare supplement, Medicare cost or Medicare
select policies to Wisconsin consumers eligible for Medicare due
to age or disability. In addition, there are 34 insurance companies
that have Medicare supplement policyholders although the
companies no longer actively market Medicare supplement
coverage in Wisconsin. At year-end 2017, there were 289,662
Wisconsin Medicare beneficiaries with Medicare supplement
policies.
10. Any analysis and supporting documentation that OCI
used in support of OCI’s determination of the rule’s effect
on small businesses under s. 227.114:
OCI reviewed financial statements and other reports filed
by life, accident and health insurers and determined that none
qualify as a small business. Wisconsin currently has 48 insurance
companies actively marketing offering Medicare supplement,
Medicare cost and Medicare select insurance policies and an
additional 34 companies supporting guaranteed renewable

policies although no longer actively marketing Medicare
supplement policies.
11. See the attached Private Sector Fiscal Analysis.
The proposed rule will not significantly impact the private
sector. Insurers offering Medicare supplement policies (Medicare
supplement, Medicare cost, and Medicare select policies) may
incur costs associated with developing new Medicare supplement
policies and marketing materials, mailing riders and explanatory
materials to existing policyholders. However, these costs are
offset by the insurers’ ability to continue offering Medicare
supplement policies to Wisconsin consumers. Further, removing
the Medicare Part B medical deductible rider as an optional
purchase to persons first eligible for Medicare on or after January
1, 2020, will not adversely impact consumers, agents or insurers
as the typical premium for rider closely approximates the actual
deductible amount that for 2019 will be $185.00.
12. A description of the Effect on Small Business:
The proposed rule will not significantly impact the private
sector. Insurers offering Medicare supplement policies (Medicare
supplement, Medicare cost, and Medicare select policies) may
incur costs associated with developing new Medicare supplement
policies and marketing materials, mailing riders and explanatory
materials to existing policyholders. However, these costs are
offset by the insurers’ ability to continue offering Medicare
supplement policies to Wisconsin consumers. Further, removing
the Medicare Part B medical deductible rider as an optional
purchase for newly eligible persons on or after January 1, 2020,
will not adversely impact consumers, agents, or insurers as the
typical premium for Medicare Part B medical deductible riders
closely approximated the actual deductible amount that for 2019
will be $185.00.
13. Agency contact person:
A copy of the full text of the proposed rule changes,
analysis and fiscal estimate may be obtained from the web site
under Rule-Making Information at: https://oci.wi.gov/Pages/
RegulationHome.aspx
or by contacting Karyn Culver, Paralegal, at:
Phone:
(608) 267-9586
Email:
karyn.culver@wisconsin.gov
Address:
125 South Webster St – 2nd Floor,
Madison WI 53703-3474
Mail:
PO Box 7873, Madison, WI 537077873
14. Place where comments are to be submitted and deadline
for submission:
The deadline for submitting comments is 4:00 p.m. on
May 21, 2019.
Mailing address:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 3.39 and 3.55,
Wis. Adm. Code.
Office of the Commissioner of Insurance
PO Box 7873
Madison WI 53707-7873
Street address:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 3.39 and 3.55,
Wis. Adm. Code.
Office of the Commissioner of Insurance
125 South Webster St – 2nd Floor
Madison WI 53703-3474
Email address:
Julie E. Walsh
Julie.Walsh@wisconsin.gov
Web site: http://docs.legis.wisconsin.gov/code
The proposed rule changes are:
SECTION 1. INS 3.13 (2) (j) (intro.), 3. and (Note) are
amended to read:
INS 3.13 (2) (j) Except as provided in s. Ins 3.39 (7) (d), (dm),
and (dt), the provision or notice regarding the right to return the
policy required by s. 632.73, Stats., shall comply with all of the
following:
3. Provide an unrestricted right to return the policy, within 10
days from the date it is received by the policyholder, to the issuer
at its home or branch office, if any, or to the agent through whom
it was purchased; except it shall provide an unrestricted right to
return the policy within 30 days of the date it is received by the
policyholder in the case of a Medicare supplement policy subject
to s. Ins 3.39 (4), (4s) (4m), (4t), (5), (5m), (5t), and (6), issued
pursuant to a direct response solicitation. Provision shall not be
made to require the policyholder to set out in writing the reasons
for returning the policy, to require the policyholder to first consult
with an agent of the issuer regarding the policy, or to limit the
reasons for return.
Note: Paragraph (j) was adopted to assist in the application
of s. 204.31 (2) (a), Stats., to the review of accident and sickness
policy and other contract forms. Those statutory requirements
are presently included in s. 632.73, Stats. The original statute
required that the provision of notice regarding the right to return
the policy must be appropriately captioned or titled. Since the
important rights given the insured are to examine the policy and
to return the policy, the rule requires that the caption or title must
refer to at least one of these rights—examine or return. Without
such reference, the caption or title is not considered appropriate.
The original statute permitted the insured to return the policy
for refund to the home office or branch office of the insurer or
to the agency with whom it was purchased. In order to assure
the refund is made promptly, some insurers prefer to instruct
the insured to return the policy to a particular office or agent
for a refund. Notices or provisions with such requirements will
be approved on the basis that the insurer must recognize an
insured’s right to receive a full refund if the policy is returned to
any other office or agent mentioned in the statute.
Also, the statute permits the insured to return a policy for
refund within 10 days from the date of receipt. Some insurers’
notices or provisions regarding such right, however, refer to
delivery to the insured instead of receipt by the insured or do not
specifically provide for the running of the 10 days from the date
the insured receives the policy. Notices or provisions containing
such wording will be approved on the basis that the insurer will
not refuse refund if the insured returns the policy within 10 days
from the date of receipt of the policy.
Sections 632.73 (2m) and 600.03 (35) (e), as created
by Chapter 82, Laws of 1981, provide for the right of return
provisions in certain certificates of group Medicare supplement
policies. Therefore, for purposes of this subparagraph, the word
policy includes a Medicare supplement certificate subject to s. Ins
3.39 (4), (4s) (4m), (4t), (5), (5m), (5t), and (6).
SECTION 2. INS 3.29 (3) (a) and (7) (b) are amended to
read:
INS 3.29 (3) (a) Group, blanket or group type, except Medicare
supplement and replacement Medicare cost insurance policies
subject to s. Ins 3.39 (4), (4s) (4m), (4t), (5), (5m), (5t), and (7).
(7) (b) The notice required by sub. (6) for a Medicare
supplement policy subject to s. Ins 3.39 (4), (4s) (4m), (4t),
(5), (5m), (5t), and (7), shall include an introductory statement
in substantially the following form: Your new policy provides
_______ days within which you may decide without cost whether
you desire to keep the policy.
SECTION 3. INS 3.39 (1) (a) and (b) are amended to read:
INS 3.39 (1) (a) This section establishes requirements for
health and other disability insurance policies primarily sold to
Medicare eligible persons. Disclosure provisions are required for
other disability policies sold to Medicare eligible person because
such policies frequently are represented to, and purchased by,
the Medicare eligible as supplements to Medicare products
including Medicare Advantage and Medicare Prescription Drug
plans.
(b) This section seeks to reduce abuses and confusion
associated with the sale of disability insurance to Medicare eligible
persons by providing for reasonable standards. The disclosure
requirements and established benefit standards are intended
to provide to Medicare eligible persons guidelines that they can
use to compare disability insurance policies and certificates as
described in s. Ins 6.75 (1) (c), and to aid them in the purchase
of policies and certificates intended to supplement Medicare and
Medicare Advantage plans policies that are suitable for their
needs. This section is designed not only to improve the ability
of the Medicare eligible consumer to make an informed choice
when purchasing disability insurance, but also to assure the
Medicare eligible persons of this state that the commissioner will
not approve a policy or certificate as “Medicare supplement” or as
a “Medicare replacement cost” unless it meets the requirements
of this section.
SECTION 4. INS 3.39 (1) (c) is repealed.
SECTION 5. INS 3.39 (1) (d) is amended to read:
INS 3.39 (1) (d) Wisconsin statutes interpreted and
implemented by this rule are ss. 185.983 (1m), 600.03, 601.01
(2), 601.42, 609.01 (1g) (b), 625.16, 628.34 (12), 628.38, 631.20
(2), 632.73 (2m), 632.76 (2) (b), 632.81, 632.895 (2), (3), (4) and
(6) and (9), Stats.
SECTION 6. INS 3.39 (2) (a) (intro.), 1. and 3. are amended
to read:
INS 3.39 (2) (a) Except as provided in pars. (d) and (e), this
section applies to any group or individual Medicare supplement
policy or certificate, or Medicare select policy or certificate as
defined described in s. 600.03 (28r), Stats., or any Medicare
replacement cost policy as defined described in s. 600.03 (28p)
(a) and (c), Stats., including all of the following:
1. Any Medicare supplement policy, Medicare select policy, or
Medicare replacement cost policy issued by a voluntary sickness
care plan subject to ch. 185, Stats.;
2. Any certificate issued under a group Medicare supplement
policy or group Medicare replacement select policy;.
3. Any individual or group policy sold in Wisconsin
predominantly to individuals or groups of individuals who are 65
years of age or older which that offers hospital, medical, surgical,
or other disability coverage, except for a policy which that offers
solely nursing home, hospital confinement indemnity, or specified
disease coverage; and.
SECTION 7. INS 3.39 (2) (a) 4. is repealed.
SECTION 8. INS 3.39 (2) (a) 5. and (b) are amended to read:
INS 3.39 (2) (a) 5. Any individual or group policy or certificate
sold in Wisconsin to persons under 65 years of age and eligible
for medicare Medicare by reason of disability which that offers
hospital, medical, surgical or other disability coverage, except
for a policy or certificate which that offers solely nursing home,
hospital confinement indemnity or specified disease coverage.
(b) Except as provided in pars. (d) and (e), subs. (9) and (11)
apply to any individual disability policy sold to a person eligible
for Medicare which that is not a Medicare supplement, Medicare
select, or a Medicare replacement cost policy as described in par.
(a).
SECTION 9. INS 3.39 (2) (c) (intro.) and 2. are consolidated
and renumbered INS 3.39 (2) (c) and, as renumbered, are
amended to read:
INS 3.39 (2) (c) Except as provided in par. (e), sub. (10)
applies to:
2. Any any individual or group hospital or medical policy which
that continues with changed benefits after the insured becomes
eligible for Medicare.
SECTION 10. INS 3.39 (2) (c) 1. is repealed.
SECTION 11. INS 3.39 (2) (d) (intro.) is amended to read:
INS 3.39 (2) (d) Except as provided in subs. (10) and (13), this
section does not apply to any of the following:
SECTION 12. INS 3.39 (2) (d) 4. is repealed.
SECTION 13. INS 3.39 (2) (e) (intro.) and 1. are amended
to read:
INS 3.39 (2) (e) This section does not apply to either of the
following:
1. A policy providing solely accident, dental, vision, disability
income, or credit disability income coverage; or.
SECTION 14. INS 3.39 (3) (c) (intro.) and 1., (ce), (e) and (f)
are amended to read:
INS 3.39 (3) (c) “Applicant” means either of the following:
1. In the case of an individual Medicare supplement, Medicare
select, or Medicare replacement cost policy, the person who
seeks to contract for insurance benefits.
(ce) “Balance bill” means seeking: to bill, charge, or collect
a deposit, remuneration or compensation from; to file or
threaten to file with a credit reporting agency; or to have any
recourse against an enrollee insured or any person acting on
the enrollee’s insured’s behalf for health care costs for which the
enrollee insured is not liable. The prohibition on recovery does
not affect the liability of an enrollee insured for any deductibles,
coinsurance or copayments, or for premiums owed under the
policy or certificate.
(e) “CMS” means the Centers for Medicare & Medicaid
Services within the U.S. department of health and human
services.
(f) “Certificate” means, any in this section, a certificate
delivered or issued for delivery in this state under a group
Medicare supplement policy or under a Medicare select policy
that is issued on a group basis, i.e. employer retiree group.
SECTION 15. INS 3.39 (3) (fm) is created to read:
INS 3.39 (3) (fm) “Certificateholder” means an individual
member of a group that is receives a certificate that identifies
the individual as a participant in the group Medicare supplement
policy or the group Medicare select policy issued in this state.
SECTION 16. INS 3.39 (3) (g) is amended to read:
INS 3.39 (g) “Certificate form” means, in this section, the form
on which the certificate is delivered or issued for delivery by the
issuer to a group that receives insurance coverage through a
group Medicare supplement policy, or a group Medicare select
policy.
SECTION 17. INS 3.39 (3) (gm) is created to read:
INS 3.39 (3) (gm) “Complaint” means any dissatisfaction
expressed by an individual concerning a Medicare select issuer
or its network providers.
SECTION 18. INS 3.39 (3) (i) 1. c. and d., and 5. a. are
amended to read:
INS 3.39 (3) (i) 1. c. Part A or Part B of Title XVIII of the Social
Security Act social security act (Medicare);
d. Title XIX of the Social Security Act social security act
(Medicaid), other than coverage consisting solely of benefits
under section 1928;

5. a. Medicare supplemental health insurance as defined
under section 1882 (g) (1) of the Social Security Act social
security act;
SECTION 19. INS 3.39 (3) (jm), and (pm) are created to
read:
INS 3.39 (3) (jm) “Grievance” means dissatisfaction with
the administration, claims practices or provision of services
concerning a Medicare select issuer or its network providers that
is expressed in writing by a policyholder or certificateholder under
a Medicare select policy or certificate.
(pm) “MACRA” means the Medicare Access and CHIP
Reauthorization Act of 2015, PL 114-10, signed April 16, 2015.
SECTION 20. INS 3.39 (3) (r) (intro.) is renumbered INS
3.39 (3) (r) and amended to read:
INS 3.39 (3) (r) “Medicare Advantage plan” means a plan of
coverage for health benefits under Medicare Part C as defined
in 42 USC 1395w-28 (b) (1), as amended, and includes any of
the following:.
SECTION 21. INS 3.39 (3) (r) 1. to 3. are repealed.
SECTION 22. INS 3.39 (3) (um) is created to read:
INS 3.39 (3) (um) “Medicare cost policy” means a Medicare
replacement policy that is offered by an issuer that has a contract
with CMS to provide coverage when services are provided
within the issuer’s geographic service area and through network
medical providers selected by the issuer. A “Medicare cost policy”
is issued to an individual who is the policyholder.
SECTION 23. INS 3.39 (3) (v) is amended to read:
INS 3.39 (3) (v) “Medicare replacement coverage policy” or
“Medicare replacement insurance policy” means coverage a
policy that meets the definition is described in s. 600.03 (28p)
(a) or (c), Stats., as interpreted by sub. (2) (a), and that provides
coverage that conforms to subs. (4), (4m), (4s) (4t), and (7).
“Medicare replacement coverage policy” includes Medicare cost
and Medicare Advantage plans policies.
SECTION 24. INS 3.39 (3) (ve), (vm), and (vs) are created
to read:
INS 3.39 (3) (ve) “Medicare select certificate” means
a policy that is issued to a group that provides Medicare
supplement coverage to the group’s members when services
are obtained through network medical providers selected by
the issuer. Individuals that receive coverage through the group
Medicare select policy receive a Medicare select certificate that
demonstrates participation in the group coverage.
(vm) “Medicare select policy” means a policy that is issued to
an individual or policyholder that provides Medicare supplement
coverage when services are obtained by the policyholder through
a network of medical providers selected by the issuer.
(vs) “Medicare supplement certificate” means a policy that is
issued to a group that provides Medicare supplement coverage to
the group’s members. Individuals that receive coverage through
the group Medicare supplement policy receive a Medicare
supplement certificate that demonstrates participation in the
group coverage.
SECTION 25. INS 3.39 (3) (w) is amended to read:
INS 3.39 (3) (w) “Medicare supplement coverage” or
“Medicare supplement insurance” means coverage that meets
the definition in s. 600.03 (28r), Stats., as interpreted by sub. (2)
(a), and that conforms to subs. (4), (4m), (4s)(4t), (5), (5m), (5t),
(6), (30), and (30m), and (30t). “Medicare supplement coverage”
is advertised, marketed or designed primarily as a supplement
to reimbursements under Medicare for the hospital, medical or
surgical expense of persons eligible for Medicare. “Medicare
supplement coverage” includes group and individual Medicare
supplement and group and individual Medicare select plans
policies and certificates but does not include coverage under
Medicare Advantage plans established under Medicare Part C or
Outpatient Prescription Drug plans established under Medicare
Part D.
SECTION 26. INS 3.39 (3) (we), (wm), and (ws) are created
to read:
INS 3.39 (3) (we) “Medicare supplement policy” means a
policy that is issued to an individual or policyholder that provides
Medicare supplement coverage.
(wm) “Network provider,” means a provider of health care, or
a group of providers of health care, which has that have entered
into a written agreement with the issuer to provide health care
benefits to an insured under a Medicare select policy or Medicare
select certificate.
(ws) “Newly eligible” means a person who meets one of the
following criteria:
1. The person has attained age 65 on or after January 1, 2020.
2. The person, by reason of entitlement to benefits under
Medicare Part A pursuant to section 226 (b) or 226A of the social
security act, or who is deemed to be eligible for benefits under
section 226 (a) of the social security act on or after January 1,
2020.
SECTION 27. INS 3.39 (3) (y) and (za) are amended to read:
INS 3.39 (3) (y) “Outline of coverage” means a printed
statement as defined by s. Ins 3.27 (5) (L), which that meets
the requirements of sub. subs. (4 ) (b), (4m) (b), or (4t) (b), as
applicable.
(za) “PACE” means Program of All–Inclusive Care for the
Elderly (PACE) under section 1894 of the Social Security Act
social security act 42 USC 1302 and 1395.
SECTION 28. INS 3.39 (3) (zag) and (zar) are created to
read:
INS 3.39 (3) (zag) “Policyholder” has the meaning provided at
s. 600.03 (37), Stat.
(zar) “Policy or certificate forms of the same type” means, for
purposes of calculating loss ratios, rates, refunds or premium
credits, each type of form filed with the commissioner including;
individual Medicare supplement policy forms, individual Medicare
select policy forms, individual Medicare cost policy forms,
group Medicare select certificate forms, and group Medicare
supplement certificate forms.
SECTION 29. INS 3.39 (3) (zb) is amended to read:
INS 3.39 (3) (zb) “Replacement” means any transaction,
other than when used to refer to an authorized Medicare
Advantage policy, wherein where new individual or group
Medicare supplement or individual Medicare cost insurance is to
be purchased, and it is known to the agent or issuer at the time
of application that, as part of the transaction, existing accident
and sickness insurance has been or is to be lapsed, cancelled
or terminated or the benefits thereof are substantially reduced.
“Replacement” includes transactions replacing a Medicare
supplement policy or certificate, Medicare select policy or
certificate, or Medicare cost policy within the same insurer or
affiliates of the insurer.
SECTION 30. INS 3.39 (3) (zbm), (zcm) and (3g) are created
to read:
INS 3.39 (3) (zbm) “Restricted network provision,” means any
provision that conditions the payment of benefits, in whole or in
part, on the use of network providers.
(zcm) “Service area” means the geographic area approved by
the commissioner within which an issuer is authorized to offer a
Medicare select policy or certificate.
(3g) Medicare eligible person. (a) Generally, an individual who
attains age 65 or older, an individual under the age of 65 with
certain disabilities, or an individual with end-stage renal disease
is eligible to enroll in Medicare. The date a person is first eligible
for Medicare Part B or first elected Medicare Part A establishes
the benefits available regardless of the date of election provided
the benefit is offered in the market. In addition to the provisions
that apply to all Medicare supplement and Medicare cost policies,
the following identify the benefits and coverage subsections that
have provisions tied to the date and year when a person is first
eligible for Medicare Parts A and B:
1. For persons first eligible for Medicare Part A and B before
June 1, 2010, subs. (4), (5), (7) (a), and (30) describe benefits
and coverage available as contained in Appendix 1, and are
applicable in addition to any provision in this section that generally
pertains to Medicare eligible persons.
2. For persons first eligible for Medicare Part A and B on or
after June 1, 2010, and prior to January 1, 2020, subs. (4m),
(5m), (7) (dm), (14m), and (30m) describe benefits and coverage
available as contained in Appendices 2m, 3m, 4m, 5m and 6m
and are applicable in addition to any provision in this section that
generally pertains to Medicare eligible persons.
3. For persons first eligible for Medicare Part A and B on or
after January 1, 2020, MACRA designated Medicare eligible
persons as “newly eligible” to distinguish them from a person
eligible prior to January 1, 2020. For these newly eligible persons,
subs. (4t), (5t), (7) (dt), (14t), and (30t) describe benefits and
coverage available as contained in Appendices 2t, 3t, 4t, 5t, and
6t and are applicable in addition to any provision in this section
that generally pertains to Medicare eligible persons.
(b) Medicare supplement policies and certificates and
Medicare select policies and certificates are guaranteed
renewable for life. Therefore, a Medicare eligible person can,
at his or her choice, elect to receive benefits and coverage
under a policy that may have fewer riders available. An insurer
may not require the Medicare eligible person to replace existing
coverage with coverage reflecting recent changes, including
changes due to MACRA. This means insurers may no longer
actively market the Medicare Part B medical deductible rider
to persons who are newly eligible for Medicare on or after
January 1, 2020. A Medicare eligible person who is first eligible
for Medicare prior to January 1, 2020, may elect the Medicare
Part B medical deductible rider coverage at any time, provided
an insurer is offering that coverage. If an insured was eligible for
Medicare prior to January 1, 2020 and elected the Medicare Part
B medical deductible rider coverage, upon renewal of the policy
or certificate that person shall be eligible to continue to receive
benefits provided by the Medicare Part B medical deductible rider
in accordance with the terms of the Medicare supplement policy
or certificate or Medicare select policy or certificate.
SECTION 31. INS 3.39 (4) (title), (intro.), (a) (intro.), 1. to 7.,
9. to 12., 16., 18., and 18p. are amended to read:
INS 3.39 (4) Medicare suppleMent policy and certificate,
Medicare select policy and certificate and Medicare replaceMent
cost policy and certificate requireMents for policies and
certificates offered to persons first eligible for Medicare prior
to June 1, 2010. Except as explicitly allowed by subs. (5), (7),

and (30), no disability insurance policy or certificate shall relate
its coverage to Medicare or be structured, advertised, solicited,
delivered or issued for delivery in this state after December 31,
1990, for policies or certificates issued to persons who were first
eligible for Medicare with effective dates prior to June 1, 2010, as
a Medicare supplement policy or certificate, as a Medicare select
policy or certificate, or as a Medicare replacement cost policy or
certificate, as defined in s. 600.03 (28p) (a) and (c), Stats., unless
it the policy or certificate complies, as applicable, with all of the
following :
(a) The Medicare supplement policy and certificate, Medicare
select policy or certificate, or the Medicare cost policy complies,
as applicable, with all the following requirements:
1. Provides only the coverage set out in sub. (5), (7), or (30)
and applicable statutes and contains no exclusions or limitations
other than those permitted by sub. (8). No issuer may issue a
Medicare cost policy, Medicare supplement policy or certificate,
or Medicare select policy or certificate without prior approval from
the commissioner and compliance with subs. (5), (7) and (30),
respectively.
2. Discloses on the first page any applicable pre-existing
preexisting conditions limitation, contains no pre-existing
preexisting condition waiting period longer than 6 months and
shall does not define a pre-existing preexisting condition more
restrictively than a condition for which medical advice was given
or treatment was recommended by or received from a physician
within 6 months before the effective date of coverage.
3. Contains no definitions of terms such as “Medicare eligible
expenses.” “accident,” “sickness,” “mental or nervous disorders,”
“skilled nursing facility,” “hospital,” “nurse,” “physician,” “Medicare
approved expenses,” “benefit period,” “convalescent nursing
home,” or “outpatient prescription drugs” that are worded less
favorably to the insured person than the corresponding Medicare
definition or the definitions contained in sub. (3), and defines
“Medicare” as in accordance with sub. (3) (q).
4. Does not indemnify against losses resulting from sickness
on a different basis from losses resulting from accident;.
5. Is “guaranteed renewable” and does not provide for
termination of coverage of a spouse solely because of an event
specified for termination of coverage of the insured, other than
the nonpayment of premium. The Medicare supplement policy or
certificate, Medicare select policy or certificate, or Medicare cost
policy shall not be cancelled or nonrenewed by the insurer on the
grounds of deterioration of health. The Medicare supplement policy
or certificate, Medicare select policy or certificate, or Medicare
cost policy may be cancelled only for nonpayment of premium or
material misrepresentation. If the Medicare supplement policy or
certificate, Medicare select policy or certificate, or Medicare cost
policy is issued by a health maintenance organization as defined
by s. 609.01 (2), Stats., the policy or certificate may, in addition to
the above reasons, be cancelled or nonrenewed by the issuer if
the insured moves out of the service area;.
6. Provides that termination of a Medicare supplement policy
or certificate, Medicare select policy or certificate, or Medicare
cost policy or certificate shall be without prejudice to a continuous
loss that commenced while the policy or certificate was in force,
although the extension of benefits may be predicated upon the
continuous total disability of the insured policyholder, limited to
the duration of the policy benefit period, if any, or payment of the
maximum benefits. Receipt of Medicare Part D benefits shall not
be considered in determining a continuous loss.
7. Contains statements on the first page and elsewhere in
the Medicare supplement policy or certificate, Medicare select
policy or certificate, or Medicare cost policy which that satisfy the
requirements of s. Ins 3.13 (2) (c), (d) or (e), and clearly states
on the first page or schedule page the duration of the term of
coverage for which the policy or certificate is issued and for which
it may be renewed. (theThe renewal period cannot be less than
the greater greatest of the following: 3 months, the period for
which the insured has paid the premium, or the period specified
in the policy); or certificate.
9. Prominently discloses any limitations on the choice of
providers or geographical area of service;.

10. Contains on the first page the designation, printed in
18-point type, and in close conjunction the caption printed in
12-point type, prescribed in sub. (5), (7), or (30);.
11. Contains text which that is plainly printed in black or blue
ink the and has a font size of which that is uniform and not less
than 10-point with a lower-case unspaced alphabet length not
less than 120-point;.
12. Contains a provision describing the review and appeal
procedure for denied claims as required by s. 632.84, Stats.,
and a provision describing any grievance rights as required by
s. 632.83, Stats., applicable to Medicare supplement policy and
certificate, Medicare select policy and certificate, and Medicare
replacement cost policies; and.
16. Except for permitted preexisting condition clauses
as described in subd. 2., no Medicare supplement policy or
certificate, Medicare select policy or certificate, or Medicare
cost policy or certificate may be advertised, solicited or issued
for delivery in this state as a Medicare supplement policy or
certificate, Medicare select policy or certificate or Medicare cost
policy if such policy or certificate contains limitations or exclusions
on coverage that are more restrictive than those of Medicare.
18. A Medicare supplement policy or certificate, Medicare
select policy or certificate or Medicare cost policy shall provide
that benefits and premiums under the policy or certificate shall be
suspended at the request of the policyholder or certificateholder
for the period not to exceed 24 months in which the policyholder
or certificateholder has applied for and is determined to be entitled
to medical assistance under Title XIX of the Social Security Act
social security act, but only if the policyholder or certificateholder
notifies the issuer of the policy or certificate within 90 days after
the date the individual becomes entitled to the assistance.
18p. Each Medicare supplement policy or certificate,
Medicare select policy or certificate or Medicare cost policy
shall provide, and contain within the policy, that benefits and
premiums under the policy or certificate shall be suspended for
any period that may be provided by federal regulation, at the
request of the policyholder or certificateholder if the policyholder
or certificateholder is entitled to benefits under section 226 (b) of
the Social Security Act social security act and is covered under
a group health plan, as defined in section 1862 (b)(1)(A)(v)of
the Social Security Act social security act. If suspension occurs
and if the policyholder or certificate holder certificateholder loses
coverage under the group health plan, the policy or certificate
shall be automatically reinstituted, effective as of the date of loss
of coverage, if the policyholder or certificateholder provides notice
of loss of coverage within 90 days after the date of such loss and
pays the premium attributable to the period, effective as of the
date of termination of enrollment in the group health plan.
SECTION 32. INS 3.39 (4) (a) 18r. (intro.) is repealed.
SECTION 33. INS 3.39 (4) (a) 18r. a. to c. are renumbered
INS 3.39 (4) (a) 18s., 18u., and 18x. and amended to read:
INS 3.39 (4) (a) 18s. Shall No Medicare supplement policy or
certificate, Medicare select policy or certificate, or Medicare cost
policy may not provide for any waiting period for resumption of
coverage that was in effect before the date of suspension under
subd. 18. with respect to treatment of preexisting conditions.
18u. Shall Each Medicare supplement policy or certificate,
Medicare select policy or certificate, or Medicare cost policy
shall provide for resumption of coverage that was in effect
before the date of suspension in subd. 18. If the suspended
Medicare supplement policy or certificate, Medicare select
policy or certificate or Medicare cost policy provided coverage
for outpatient prescription drugs, reinstitution resumption of the
policy shall be without coverage for outpatient prescription drugs
and shall otherwise provide substantially equivalent coverage
to the coverage in effect before the date of suspension. If the
suspended Medicare supplement policy or certificate, Medicare
select policy or certificate or Medicare cost policy provided
coverage of Medicare Part B medical deductible coverage or if
the insured was enrolled or Medicare eligible prior to January 1,
2020, and the insurer offers a plan with Medicare Part B medical
deductible coverage then the policyholder or certificateholder
may elect or renew coverage with the Medicare Part B medical
deductible coverage. If the insurer no longer offers a plan with
the Medicare Part B medical deductible coverage, then the
insurer shall provide the policyholder or certificateholder with
substantially equivalent coverage to the coverage in effect prior
to the date of suspension.
18x. Shall Each Medicare supplement policy or certificate,
Medicare select policy or certificate, or Medicare cost policy shall
provide for that upon the resumption of coverage that was in
effect before the date of suspension in subd. 18. classification of
premiums shall be on terms at least as favorable to the policyholder
or certificateholder as the premium classification terms that would
have applied to the policyholder or certificateholder had the
coverage not been suspended.
SECTION 34. INS 3.39 (4) (b) (intro.), and 1. to 7., (c), (e),
and (g) are amended to read:
INS 3.39 (4) (b) The outline of coverage for the Medicare
supplement policy or certificate, Medicare select policy or
certificate, or Medicare cost policy or certificate. shall comply with
all of the following:
1. Is provided to all applicants at the time application is made
and, except in the case of direct response insurance, the issuer
obtains written acknowledgement from the applicant that the
outline was received;.
2. Complies with s. Ins 3.27, including s. Ins 3.27 (5) (L) and
(9) (u) (v) and (zh) 2.
and 4.
3. Is substituted to properly describe the Medicare supplement
policy or certificate, Medicare select policy or certificate, or
Medicare cost policy or certificate as issued, if the outline provided
at the time of application did not properly describe the coverage
which was issued. The substituted outline shall accompany
the Medicare supplement policy or certificate, Medicare select
policy or certificate, or Medicare cost policy or certificate when
it is delivered and shall contain the following statement in no
less than 12-point type and immediately above the company
name: “NOTICE: Read this outline of coverage carefully. It is not
identical to the outline of coverage provided upon application, and
the coverage originally applied for has not been issued.”;
4. Contains in close conjunction on its first page the
designation, printed in a distinctly contrasting color in 24-point
type, and the caption, printed in a distinctly contrasting color in
18-point type prescribed in sub. (5), (7) or (30);.
5. Is substantially in the format prescribed in Appendix 1 to
this section for the appropriate category and printed in no less
than 12-point type;.
6. Summarizes or refers to the coverage set out in applicable
statutes;.
7. Contains a listing of the required coverage as set out in
sub. (5) (c) and the optional coverages as set out in sub. (5) (i),
and the annual premiums therefor, for each selected coverage,
substantially in the format of sub. (11) of Appendix 1; and.
(c) Any rider or endorsement added to the Medicare
supplement policy or certificate, Medicare select policy or
certificate, or Medicare cost policy or certificate shall comply with
all of the following:
1. Shall be set forth contained in the policy or certificate and,
if a separate, additional premium is charged in connection with
the rider or endorsement, the premium charge shall be set forth
stated in the policy or certificate; and.
2. After Shall be agreed to in writing signed by the insured if,
after the date of the Medicare supplement policy or certificate,
Medicare select policy or certificate, or Medicare cost policy
or certificate issue, shall be agreed to in writing signed by the
insured, if the rider or endorsement increases benefits or
coverage with an and there is an accompanying increase in
premium during the term of the policy or certificate, unless the
increase in benefits or coverage is required by law.
3. Shall only provide coverage as defined described in sub.
(5) (i) or provide coverage to meet statutory Wisconsin mandated
provisions.
(e) The anticipated loss ratio for any new Medicare supplement
policy or certificate, Medicare select policy or certificate, or
Medicare cost policy or certificate form, that is, or the expected
percentage of the aggregate amount of premiums earned that
will be returned to insureds in the form of aggregate benefits, not
including anticipated refunds or credits, that is provided under the
policy or certificate form:
1. Is computed on the basis of anticipated incurred claims
or incurred health care expenses where coverage is provided
by a health maintenance organizations on a service rather than
reimbursement basis and earned premiums for the entire period
for which the policy form provides coverage, in accordance with
accepted actuarial principles and practices.; and
2. Is submitted to the commissioner along with the policy or
certificate form and is accompanied by rates and an actuarial
demonstration that expected claims in relationship to premiums
comply with the loss ratio standards in under sub. (16) (d). The
policy or certificate form will not be approved by the commissioner
unless the anticipated loss ratio along with the rates and actuarial
demonstration show compliance with sub. (16) (d).
(g) As regards For subsequent rate changes to the policy or
certificate form, the insurer shall do all of the following:
1. Files such File the rate changes on a rate change transmittal
form in a format specified by the commissioner.
2. Includes Include in its the filing under subd.1. an actuarially
sound demonstration that the rate change will not result in a loss
ratio over the life of the policy or certificate which that would
violate the requirements under sub. (16) (d).
SECTION 35. INS 3.39 (4m) is renumbered INS 3.39 (3r)
and INS 3.39 (3r) (a), (b) and (d) as renumbered, are amended
to read:
INS 3.39 (3r) OPEN ENROLLMENT. (a) An issuer may not
deny nor condition the issuance or effectiveness of, or discriminate
in the pricing of, basic Medicare supplement coverage policies or
certificates, Medicare cost policy, or Medicare select policies or
certificates permitted, as applicable, under subs. (5), (5m), (5t),
(7), and (30), (30m), (30t), or riders permitted under sub. (5) (i),
(5m) (e), or (5t) (e), for which an application is submitted prior
to or during the 6-month period beginning with the first month in
which that an individual first enrolled for benefits under Medicare
Part B or the month in which that an individual turns age 65 for
any individual who was first enrolled in Medicare Part B when
under the age of 65 on any of the following grounds:
(b) Except as provided in pars. (c) and (d), and sub. (34),
this section shall not prevent the application of any pre-existing
preexisting condition limitation that is in compliance with sub. (4)
(a) 2.
(d) If the applicant qualifies under par. (a) and submits an
application during the time period referenced in par. (a) and, as of
the date of application, has had a continuous period of creditable
coverage that is less than 6 months, the issuer shall reduce the
period of any pre-existing preexisting condition exclusion by the
aggregate of the period of creditable coverage applicable to the
applicant as of the enrollment date. The Secretary secretary shall
specify the manner of the reduction under this paragraph.
SECTION 36. INS 3.39 (4s) (intro.), (a) (intro.), and 1. to 20.
are renumbered INS 3.39 (4m) (title), (intro.), (a) (intro.) and
1. to 20., and INS 3.39 (4m) (title), (intro.), (a) (intro.), 1., 3., 6.,
11., and 12. as renumbered, are amended to read:
INS 3.39 (4m) Medicare suppleMent policy and certificate,
Medicare select policy and certificate, and Medicare replaceMent
cost policy and certificate requireMents for policies and
certificates offered to persons first eligible for Medicare on
or after June 1, 2010, and prior to January 1, 2020. Except as

explicitly allowed by subs. (5m) and (30m), no disability insurance
policy or certificate shall relate its coverage to Medicare or be
structured, advertised, marketed or issued to persons first eligible
for Medicare on or after June 1, 2010, and prior to January 1,
2020, as a Medicare supplement policy or certificate, Medicare
select policy or certificate, or as a Medicare replacement cost
policy or certificate, as defined in s. 600.03 (28p) (a) and (c),
Stats., unless it the policy or certificate complies with all of the
following:
(a) The policy or certificate shall comply with all of the
following requirements:
1. Provides only the coverage set out in sub. (5m), (7), or
(30m) and applicable statutes and contains no exclusions or
limitations other than those permitted by sub. (8). No issuer
may issue a Medicare cost policy or Medicare select policy or
certificate without prior approval from the commissioner and
compliance with sub. (30m).
3. Contains no definitions of terms such as “Medicare eligible
expenses,” “accident,” “sickness,” “mental or nervous disorders,”
skilled nursing facility,” “hospital,” “nurse,” “physician,” “Medicare
approved expenses,” “benefit period,” “convalescent nursing
home,” or “outpatient prescription drugs” that are worded less
favorably to the insured person than the corresponding Medicare
definition or the definitions contained in sub. (3), and defines
“Medicare” as in accordance with sub. (3) (q).
6. Provides that termination of a Medicare supplement policy
or certificate, Medicare select policy or certificate, or Medicare
cost policy or certificate shall be without prejudice to a continuous
loss that commenced while the policy or certificate was in force,
although the extension of benefits may be predicated upon the
continuous total disability of the insured, limited to the duration
of the policy or certificate benefit period, if any, or payment of the
maximum benefits. Receipt of the Medicare Part D benefits may
not be considered in determining a continuous loss.
11. Contains text that is plainly printed in black or blue ink
the size of which and has a font size that is uniform and not less
than 10-point type with a lower-case unspaced alphabet length
not less than 120-point type.
12. Contains a provision describing the review and appeal
procedure for denied claims required by s. 632.84, Stats., and
a provision describing any grievance rights as required by s.
632.83, Stats., applicable to Medicare supplement policies and
certificates and Medicare replacement cost policies or certificates.
SECTION 37. INS 3.39 (4s) (a) 21. (intro.) is repealed.
SECTION 38. INS 3.39 (4s) (a) 21. a., b., and c. are
renumbered INS 3.39 (4m) (a) 21e., 21m., and 21s. and
amended to read:
INS 3.39 (4m) (a) 21e. May No Medicare supplement policy or
certificate, Medicare select policy or certificate, or Medicare cost

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